phenylephrine-hydrochloride and Sleep-Apnea--Obstructive

A reliable method for analyzing the upper airway (UA) remains a challenge. This study aimed to report the methods for UA assessment using cone-beam computed tomography (CBCT) in adults with obstructive sleep apnea (OSA).. We performed a systematic review (PROSPERO #CRD42021237490 and PRISMA checklist) that applied a search strategy to seven databases and grey literature.. In 29 studies with moderate-to-high risk of bias, investigators mostly reported the body position during CBCT (upright or supine) and hard tissue references, diverging in UA delimitation and terminologies. The meta-analysis showed two subgroups (upright and supine), and no statistical differences were identified (p = 0.18) considering the UA area. The volume in the OSA group was smaller than that in the control group (p < 0.003 and Cohen's d =  - 0.81) in the upright position. Patients with OSA showed smaller anteroposterior dimensions than the control group and were not affected by the position during image acquisition (p = 0.02; Cohen's d =  - 0.52). The lateral measurements were also lower in the OSA group (supine) (p = 0.002; Cohen's d =  - 0.6).. Patients with OSA showed smaller UA measurements in the upright (volume) and supine (lateral dimension) positions. The anteroposterior dimension was also reduced in patients with OSA compared to the control group, regardless of the position during CBCT acquisition.

Topics: Adult; Cone-Beam Computed Tomography; Humans; Nose; Posture; Sleep Apnea, Obstructive

The purpose of this study was to compare the effectiveness of nasal pillows with standard nasal masks in the treatment of patients with obstructive sleep apnea (OSA).. A digitalized search was carried out in four different databases including PubMed, Scopus, EMBASE, and CENTRAL using relevant keywords along with a manual search in relevant journals. All comparative studies comparing outcomes of using a nasal pillow with the use of standard nasal masks for continuous positive airway pressure (CPAP) treatment in patients with OSA were included. The qualitative analysis was carried out by tabulating the demographic data. The quantitative data were subjected to meta-analysis. The quality of comparative studies (both retrospective and prospective cohorts) was evaluated using New-castle Ottawa scale (NOS).. A total of 14 studies (eight prospective and six retrospective) were included in the review. Of them, five studies were randomized and were of cross-over study design. No significant differences were observed in achieved CPAP and residual apnea-hypopnea index (AHI) levels between the nasal pillow and nasal mask with SMD - 0.05 95% CI [- 0.18, 0.09], p = 0.50 and SMD - 0.13 95% CI [- 0.28, 0.03], p = 0.12, respectively. However, nasal pillow usage was associated with better CPAP adherence with a difference of only + 0.29 min/night as compared to a standard nasal mask, with SMD 0.29 95% CI [0.07, 0.50], p = 0.009.. Nasal pillow and standard nasal mask were equally effective in terms of residual AHI level and achieved similar therapeutic CPAP pressures. However, the difference in CPAP adherence between groups, though statistically significant, is of questionable clinical significance.

Topics: Continuous Positive Airway Pressure; Cross-Over Studies; Humans; Nose; Prospective Studies; Retrospective Studies; Sleep Apnea, Obstructive

This review aims to provide current knowledge about the efficacy, mechanism, and multidisciplinary collaboration of rapid maxillary expansion (RME) treatment in pediatric obstructive sleep apnea (OSA). OSA is a chronic disease characterized by progressively increasing upper airway resistance, with various symptoms and signs. Increasingly the evidence indicates that RME is a non-invasive and effective therapy option for children with OSA. Besides, the therapeutic mechanism of RME includes increasing upper airway volume, reducing nasal resistance, and changing tongue posture. Recent clinical researches and case reports also show that a multidisciplinary approach improves sleep-disordered breathing in children. Applied with adenotonsillectomy, mandibular advancement, continuous positive airway pressure, and comprehensive orthodontic treatment, RME can be more effective in recurrent or residual OSA.

Topics: Child; Humans; Mandibular Advancement; Nose; Palatal Expansion Technique; Sleep Apnea Syndromes; Sleep Apnea, Obstructive

Upper airway (UA) collapsibility is one of the key factors that determine the severity of obstructive sleep apnea (OSA). Interventions for OSA are aimed at reducing UA collapsibility, but selecting the optimal alternative intervention for patients who fail CPAP is challenging because currently no validated method predicts how anatomical changes affect UA collapsibility. The gold standard objective measure of UA collapsibility is the pharyngeal critical pressure (P

Topics: Humans; Nose; Pharynx; Polysomnography; Sleep Apnea, Obstructive; Tongue

Obstructive sleep apnea hypopnea syndrome (OSAHS) is a common sleep respiratory disorder characterized by upper respiratory collapse during sleep, with a high prevalence and potentially fatal complications. Currently, maxillary transverse deficiency are considered to be an important pathogenic factor of OSAHS. For patients with poor compliance with positive airway pressure therapy, rapid maxillary expansion can increase the volume and ventilation of the upper respiratory tract, which is an alternative treatment. This paper reviewed the current research on surgically assisted rapid palatal expansion, miniscrew assisted rapid palatal expansion, and distraction osteogenesis maxillary expansion in the treatment of adult OSAHS. By comparing the indications, contraindications, complications, efficacy and long-term stability of the three treatment methods, it provided reference for treatment of patients with OSAHS.. 阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome，OSAHS）是一种常见的睡眠呼吸疾病，其患病率高，有潜在的致死性并发症。目前，上颌横向缺陷被认为是OSAHS的重要致病因素，对持续气道正压通气疗法依从性不佳的患者，上颌快速扩弓可增加上呼吸道容积及通气量，是一种替代治疗方法。本文就外科辅助上颌快速扩弓、种植体支抗辅助上颌快速扩弓、牵张成骨辅助上颌扩弓治疗成人OSAHS的研究现状进行综述，通过对比3种术式的适应证、禁忌证、并发症、疗效及其长期稳定性，为临床治疗方案的选择提供参考。.

Topics: Adult; Humans; Nose; Palatal Expansion Technique; Palate; Sleep Apnea, Obstructive; Syndrome

The treatment of obstructive sleep apnea is often impeded by intolerance of positive airway pressure therapy, which is frequently attributed to the inability to breathe through the nose. Providers caring for patients with sleep apnea need a working knowledge of nasal passage disease and available treatments to better manage this common comorbidity.. This review examines the literature connecting rhinosinusitis to adverse sleep and sleep apnea outcomes. It explores the different types of nasal and sinus diseases a sleep apnea provider might encounter, focusing on the medications used to treat them and indications for referral to otolaryngology.. Chronic rhinosinusitis can be either allergic or nonallergic. Both types can interfere with sleep and sleep apnea therapy. The successful management of chronic rhinosinusitis can improve positive airway pressure tolerance and adherence. A wide range of over-the-counter and prescription pharmacotherapy is available, with data supporting intranasal over oral treatment. Surgical treatment for chronic rhinosinusitis in obstructive sleep apnea addresses nasal obstruction, often with inferior turbinate reduction and septoplasty.. Sleep specialists should have a working knowledge of the available options to treat chronic rhinosinusitis. These options are often safe, effective, and readily accessible. Otolaryngologists and allergists/immunologists provide additional treatment options for more complicated patients. Providing treatment for chronic rhinosinusitis should be included as part of comprehensive sleep apnea care.. Ali MM, Ellison M, Iweala OI, Spector AR. A sleep clinician's guide to runny noses: evaluation and management of chronic rhinosinusitis to improve sleep apnea care in adults.

Topics: Administration, Intranasal; Adult; Humans; Nose; Rhinorrhea; Sinusitis; Sleep; Sleep Apnea, Obstructive

To evaluate the efficiency of maxillomandibular advancement using aggregated individual patient data from multiple studies.. This overview was structured according to the PICO strategy. It adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist and was recorded on the international prospective register of systematic reviews (PROSPERO-CRD42020206135). Searches were conducted in the PubMed/MEDLINE, Scopus, Embase, Web of Science, LILACS, and Cochrane databases for studies published until January 1, 2021. Data from the included studies were collected by one author, while another reviewed the compilation.. Twelve systematic reviews were included. The outcome measures studied were the apnea-hypopnea index, respiratory disturbance index, mean oxygen saturation, lowest oxygen saturation, sleepiness data, posterior air space, sella-nasion point A angle, sella-nasion point B angle, surgical success, and surgical cure in patients who underwent surgery. The AMSTAR scale presented moderate evaluations, with grades varying between 6 and 10 points. The Glenny scale revealed that the study selection did not include all languages. Only three reviews identified quality assessments conducted by at least two reviewers and only five related possible searches for unpublished data.. Bimaxillary advancement surgery improved respiratory indicators, sleepiness data, and increased upper airway size. However, it is necessary to standardize the surgical criteria to establish measurable efficiency of the procedure.. This overview makes a critical analysis of the results of the selected systematic reviews with the aim of presenting the most clinically relevant data on the maxillomandibular advancement for treating obstructive apnea syndrome, with a focus on improving respiratory, anatomical, and quality of life indices. There are no overviews that approach this theme from a well-structured perspective.

Topics: Humans; Mandibular Advancement; Nose; Quality of Life; Sleep Apnea, Obstructive; Sleepiness; Treatment Outcome

Obstructive sleep apnea (OSA) is common in infants and children with craniofacial malformations. Continuous positive airway pressure (CPAP) represents an effective noninvasive treatment for severe upper airway obstruction in these children, reducing the need of surgery or a tracheostomy. The decision to start CPAP should be discussed by a multidisciplinary team in order to decide the optimal individualized treatment strategy. CPAP initiation depends on patients' clinical characteristics and local practices, with an increase tendency towards an outpatient program. Follow-up and monitoring strategy varies among centers but benefits from the analysis of built-in software data in order to assess objective adherence and breathing parameters, reducing the need of in-hospital sleep studies. The possibility to wean CPAP should be periodically checked after surgical treatment or when spontaneous resolution is suspected. Finally, these infants with craniofacial malformations should have a long term follow up because of the risk of OSA recurrence over time.

Topics: Child; Continuous Positive Airway Pressure; Humans; Infant; Nose; Polysomnography; Sleep Apnea, Obstructive; Treatment Outcome

Identification of the obstruction site in the upper airway may help in treatment selection for patients with sleep-disordered breathing. Because of limitations of existing techniques, there is a continuous search for more feasible methods. Snoring sound parameters were hypothesized to be potential predictors of the obstruction site. Therefore, this review aims to i) investigate the association between snoring sound parameters and the obstruction sites; and ii) analyze the methodology of reported prediction models of the obstruction sites.. The literature search was conducted in PubMed, Embase.com, CENTRAL, Web of Science, and Scopus in collaboration with a medical librarian. Studies were eligible if they investigated the associations between snoring sound parameters and the obstruction sites, and/or reported prediction models of the obstruction sites based on snoring sound.. Of the 1016 retrieved references, 28 eligible studies were included. It was found that the characteristic frequency components generated from lower-level obstructions of the upper airway were higher than those generated from upper-level obstructions. Prediction models were built mainly based on snoring sound parameters in frequency domain. The reported accuracies ranged from 60.4% to 92.2%.. Available evidence points toward associations between the snoring sound parameters in the frequency domain and the obstruction sites in the upper airway. It is promising to build a prediction model of the obstruction sites based on snoring sound parameters and participant characteristics, but so far snoring sound analysis does not seem to be a viable diagnostic modality for treatment selection.

Topics: Airway Obstruction; Humans; Nose; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Snoring; Sound

Nasal obstruction is a common complaint in patients with sleep-disordered breathing and obstructive sleep apnea (OSA). Although topical nasal treatments (TNTs) have been shown to reduce nasal resistance and improve nasal obstruction, there is conflicting evidence regarding the role of TNTs in adult OSA. In this systematic review and meta-analysis we aim to evaluate the role of TNTs in adults with OSA. Data sources used included PubMed, Ovid MEDLINE, and Cochrane Central, from January 2001 to July 2019.. Inclusion criteria were English-language studies containing original data on TNTs in adults (≥18 years) with OSA (apnea-hypopnea index [AHI] ≥5). Exclusion criteria were case reports, studies without outcome measures, and concurrent non-TNT treatment for OSA. Two investigators independently reviewed all articles and performed quality assessment using validated tools. Meta-analysis and quality assessment were performed.. Of the 2180 abstracts identified, 8 studies met inclusion criteria. TNTs included decongestants (4 of 8 studies), corticosteroids (3 of 8), and antihistamines (1 of 8). Outcome measures included AHI (8 of 8), respiratory distress index (RDI; 1 of 8), oxygen-desaturation index (ODI; 3 of 8), minimum SaO2 (MinSaO. TNTs may improve minimum oxygen saturation, ODI, RDI, and subjective/quality-of-life measures. Allergic patients may have more improvement in OSA measures compared with nonallergic patients. Future studies are indicated to accurately determine the efficacy of TNTs.

Topics: Adult; Humans; Nasal Obstruction; Nose; Quality of Life; Sleep Apnea, Obstructive; Treatment Outcome

It is estimated that half of the adult population older than 60 years snores. This article discusses the many aspects of snoring, including impacts on bed partners, the individual who snores, and when and how to appropriately evaluate, diagnose, and treat the perpetrator. The goal is for clinicians to expand their knowledge regarding diagnosis and treatment of the phenomenon of snoring.It is estimated that half of the adult population over the age of 60 years of age snores. This chapter discusses snoring, including the impact on bed partners, the individual that snores and when and how to treat the snorer. The goal is for clinicians to expand their knowledge regarding diagnosis and treatment of patients who snores.

Topics: Airway Obstruction; Humans; Nasopharynx; Nose; Polysomnography; Sleep Apnea, Obstructive; Snoring; Sound Spectrography

To evaluate the effect of the different surgical techniques used in the treatment of obstructive sleep apnea (OSA) on the postoperative voice and nasalance, and to conduct a meta-analysis through the assessment of postoperative changes.. Systematic literature review and meta-analysis of published data using the data sources, MEDLINE, Google Scholar, Cochrane, and SAGE. All studies published in English specifying any upper airway surgery for treatment of snoring and/or OSA were included, provided they indicated the pre- and postoperative mean ± standard deviation (SD) values for voice parameters and nasality. The primary outcomes were the changes in preoperative-postoperative mean values of fundamental frequency (mF0), jitter, shimmer, and nasalance scores.. After removal of duplications, 214 studies were potentially relevant, and 25 studies ultimately met the criteria for inclusion in the present review. Of the 25 studies evaluated in this review, 12 studies with 379 patients were available for the meta-analysis calculations. In general, a fixed-effects model was used to analyze the data in the subgroups. The meta-analysis results showed no significant differences in either subgroup analysis between the preoperative and postoperative assessments of mF0, jitter, shimmer, oral nasalance, nasal nasalance, and oronasal nasalance (All had values of p > 0.05).. The results of this meta-analysis indicated no significant effect of surgical treatments for snoring or OSA on glottic functioning and nasalance parameters, regardless of surgery type. Further prospective studies are needed to assess more parameters for detailed acoustic analyses.

Topics: Humans; Nose; Prospective Studies; Sleep Apnea, Obstructive; Snoring; Treatment Outcome; Voice

The upper airway is a collapsible tube, and its collapsibility increases during sleep. Extrinsic factors such as atypical craniofacial features may increase the risks of airway collapse. We review early development of oral-facial structures and the anatomical variants that may be present at birth and can impact nasal breathing. After birth, there is a continuous interaction between orofacial functions and growth of anatomic features. We review the dysfunctions identified to date that may impact orofacial development leading to sleep-disordered-breathing through changes in the orofacial growth. The identification of risk-factors, ultimately leading to full-blown obstructive sleep apnea, may allow early recognition of these factors and the development of treatments to eliminate early problems or at least decrease their impact.

Topics: Child; Craniofacial Abnormalities; Humans; Nose; Pediatrics; Pharynx; Risk Factors; Sleep Apnea, Obstructive

Upper airway changes following bimaxillary advancement surgery to treat obstructive sleep apnea syndrome remain controversial. The main objective of this systematic review and meta-analysis was to investigate the effects of bimaxillary advancement surgery on the upper airway (UA) of obstructive sleep apnea syndrome patients through examining changes three-dimensionally in vertical and supine position and through changes in oximetric variables (AHI, RDI, O2 Sat) and in the quality of life measured by the Epworth sleepiness scale (ESS). A thorough search of the PubMed, Scopus, Embase and Cochrane databases and a grey literature search (Opengrey) were conducted. No limit was placed on publication year or language. The inclusion criteria were: adult obstructive sleep apnea patients who had undergone bimaxillary advancement surgery, three-dimensional CBCT or CT and oximetric measurements and at least six weeks follow-up. Sample sizes of under 10 patients were excluded. Finally, 26 articles were included in the qualitative review and 23 in the meta-analysis. Bimaxillary advancement surgery has been shown to be beneficial in terms of increased upper airway size, improved oximetric indicators and the quality of life measured on the Epworth sleepiness scale.

Topics: Adult; Humans; Larynx; Nose; Orthognathic Surgical Procedures; Oximetry; Quality of Life; Sleep Apnea, Obstructive; Treatment Outcome

Topics: Airway Obstruction; Endoscopy; Humans; Nose; Sleep; Sleep Apnea, Obstructive; Syndrome

Background /Aims: The aim of this study was to determine the effect of upper airway surgery (UAS) on continuous positive airway pressure (CPAP). A secondary objective was to determine if a decrease in CPAP from UAS increases CPAP adherence.. Studies were eligible for inclusion if a CPAP titration was performed both prior and following UAS in patients with obstructive sleep apnea (OSA). Studies that compared adherence to CPAP before and after UAS were included to evaluate the secondary objective.. A total of 11 articles involving 323 patients were included in the review. The results show that there was a mean reduction in CPAP of 1.40 cm H2O (95% CI -2.08 to -0.73). Four of the 11 papers, with a total of 80 patients, evaluated CPAP adherence and found a significant 0.62-hour improvement on average (95% CI 0.22-1.01).. Due to high levels of nonadherence, surgical intervention will play a role even in patients who are unlikely to be fully cured by surgery. UAS decreases the apnea-hypopnea index and modestly reduces CPAP while improving CPAP adherence in the majority of patients. The evidence suggests that UAS may have an adjunctive role in the management of OSA.

Topics: Continuous Positive Airway Pressure; Humans; Nose; Palate; Patient Compliance; Pharynx; Severity of Illness Index; Sleep Apnea, Obstructive

Continuous positive airway pressure (CPAP) delivered by nasal mask is the gold standard treatment for obstructive sleep apnea (OSA). However, oral and oronasal masks are also available. We considered experimental evidence and reviewed clinical trials that evaluated the impact of oral and oronasal mask on OSA treatment.. One recent study in 18 OSA patients that slept with a customized oronasal mask with two sealed compartments showed that the change of CPAP flow from nasal to oronasal and oral caused upper airway obstruction because of posterior displacement of the tongue demonstrated by nasoendoscopy. Oral masks use a mouthpiece that may stabilize the jaw and the tongue and have shown to be effective. However, oral masks are not widely used in clinical practice. Four out of five observational studies and all five reviewed randomized studies showed a worse performance of oronasal when compared with nasal masks. Oronasal masks were associated with higher residual apnea-hypopnea index, lower adherence, more leaks, and less satisfaction than nasal mask in the majority of the studies.. Nasal CPAP must be the first choice to treat OSA. Patients on oronasal mask should be carefully followed. VIDEO ABSTRACT.

Topics: Continuous Positive Airway Pressure; Humans; Male; Masks; Nose; Sleep Apnea, Obstructive

This review highlights recent advances and views on the role of the nose in snoring and obstructive sleep apnoea.. Recent reviews and past randomized controlled trials generally agree that nasal surgery may improve quality of life in snoring and obstructive sleep apnoea. There have been no published randomized controlled trials regarding nasal treatments in snoring or obstructive sleep apnoea in the past year.. Snoring and obstructive sleep apnoea are upper airway disorders in which the role of the nose has been well researched. Studies support that nasal surgery improves quality of life in snoring, but it may not lead to resolution of snoring. Likewise, nasal treatments for obstructive sleep apnoea increase the quality of life and treatment compliance in some patients. Further stratification of patients who may benefit from nasal intervention may clarify the role of nasal surgery.

Topics: Humans; Nose; Quality of Life; Sleep Apnea, Obstructive; Snoring

Topics: Adult; Airway Remodeling; Child; Craniofacial Abnormalities; Disease Progression; Humans; Nasal Obstruction; Nose; Nose Deformities, Acquired; Obesity; Pharynx; Rhinitis; Risk Factors; Sleep Apnea, Obstructive; Trachea

Sleep disordered breathing (SDB) is a common condition and could be a risk factor for cardiovascular morbidity and mortality. However, the pathogenesis of SDB remains to be elucidated. In general, SDB is divided into two forms, obstructive and central sleep apnea (OSA and CSA, respectively). OSA results from the sleep-related collapse of the upper airway (UA) in association with multiple factors like race, gender, obesity and UA dimensions. CSA primarily results from a fall in PaCO2 to a level below the apnea threshold during sleep through the reflex inhibition of central respiratory drive. It has been reported that UA alterations (i.e., collapse or dilation) can be observed in CSA. This review highlights the roles of the UA in the pathogenesis and pathophysiology of SDB.

Topics: Airway Obstruction; Cardiovascular Diseases; Female; Humans; Male; Nasal Obstruction; Nose; Obesity; Palatal Muscles; Pharyngeal Muscles; Pharynx; Respiratory Mechanics; Risk Factors; Sex Factors; Sleep; Sleep Apnea, Central; Sleep Apnea, Obstructive; Wakefulness

A surgical approach to treatment of obstructive sleep apnoea (OSA) remains an area of intense debate, both within and without the surgical community itself. Continuous positive airway pressure (CPAP) therapy remains the gold standard for the treatment of OSA, however surgery may be indicated to facilitate CPAP and/or improve compliance in cases where CPAP is poorly tolerated. This article summarises the current range of surgical treatment options together with the evidence base for their intervention in otolaryngology, maxillofacial and bariatric surgery. The continued evolution of technology has brought new surgical techniques to the fore and it seems likely their utilisation together with a multi-level surgical approach to the airway will continue to influence forthcoming research in OSA. Patient selection and precise evaluation will remain crucial in ensuring that when surgery is indicated, the correct procedure or procedures are performed at the correct anatomical level.

Topics: Adult; Bariatric Surgery; Humans; Hypopharynx; Minimally Invasive Surgical Procedures; Nose; Palate; Robotic Surgical Procedures; Sleep Apnea, Obstructive; Tongue; Tonsillectomy

The original indication for rapid palatal expansion was to treat skeletal maxillary constriction. As positive effects were clinically proven, the number of indications for rapid palatal expansion has continuously grown. The purpose of the present article was to review the literature and to evaluate the effect of rapid palatal expansion on nose breathing, natural head position, obstructive sleep apnoea syndrome, nocturnal enuresis and conductive hearing loss.. It can be concluded that rapid palatal expansion is predominantly recommended in children with maxillary constriction. In those with normal occlusion, maxillary expansion can be considered as the really last choice of treatment when other treatment options in patients with nose breathing, obstructive sleep apnea syndrome (OSAS), nocturnal enuresis and conductive hearing loss (CHL) have failed. Therefore, collaboration between paediatricians, otolaryngologists, paediatric dentists and orthodontists will lead to the best treatment outcomes in the future.

Topics: Child; Head; Health Status; Hearing Loss, Conductive; Humans; Nocturnal Enuresis; Nose; Palatal Expansion Technique; Respiration; Sleep Apnea, Obstructive

A variety of causes may result in nasal obstruction including allergic and non-allergic rhinitis, anatomic abnormalities, and postoperative nasal packing. There is both an epidemiological and clinical relationship between nasal obstruction and sleep disordered breathing. Subsequently, improving nasal patency via surgical or non-surgical means is expected to relieve sleep disordered breathing. The present review will discuss and review some of the literature related to the pathophysiological interaction of the human nose and sleep disordered breathing and provide a summary of the effects of related intervention trials.

Topics: Humans; Models, Biological; Nasal Obstruction; Nose; Respiratory Mechanics; Sleep Apnea, Obstructive; Treatment Outcome

Pediatric sleep-disordered breathing is a continuum, with primary snoring at one end, and complete upper airway obstruction, hypoxemia, and obstructive hypoventilation at the other. The latter gives rise to obstructive sleep apnea. An important predisposing factor in the development and progression of pediatric sleep-disordered breathing might be craniofacial disharmony. The purpose of this systematic review and meta-analysis was to elucidate the association between craniofacial disharmony and pediatric sleep-disordered breathing.. Citations to potentially relevant published trials were located by searching PubMed, Embase, Scopus, and the Cochrane Central Register of Controlled Trials. The MetaRegister of controlled trials database was also searched to identify potentially relevant unpublished trials. Additionally, hand-searching, Google Scholar searches, and contact with experts in the area were undertaken to identify potentially relevant published and unpublished studies. Inclusion criteria were (1) randomized controlled trials, case-control trials, or cohort studies with controls; (2) studies in nonsyndromic children 0 to 18 years of age with a diagnosis of sleep-disordered breathing or obstructive sleep apnea by either a sleep disorders unit, screening questionnaire, or polysomnography; and (3) principal outcome measures of craniofacial or upper airway dimensions or proportions with various modalities of imaging for the craniofacial and neck regions. The quality of the studies selected was evaluated by assessing their methodologies. Treatment effects were combined by meta-analysis with the random-effects method.. Children with obstructive sleep apnea and primary snoring show increased weighted mean differences in the ANB angle of 1.64° (P <0.0001) and 1.54° (P <0.00001), respectively, compared with the controls. An increased ANB angle was primarily due to a decreased SNB angle in children with primary snoring by 1.4° (P = 0.02). Children with obstructive sleep apnea had a distance from the posterior nasal spine to the nearest adenoid tissue measured along the PNS-basion line reduced by 4.17 mm (weighted mean difference) (P <0.00001) and a distance from the posterior nasal spine to the nearest adenoid tissue measured along the line perpendicular to the sella-basion line reduced by 3.12 mm (weighted mean difference) (P <0.0001) compared with the controls.. There is statistical support for an association between craniofacial disharmony and pediatric sleep-disordered breathing. However, an increased ANB angle of less than 2° in children with obstructive sleep apnea and primary snoring, compared with the controls, could be regarded as having marginal clinical significance. Therefore, evidence for a direct causal relationship between craniofacial structure and pediatric sleep-disordered breathing is unsupported by this meta-analysis. There is strong support for reduced upper airway width in children with obstructive sleep apnea. Larger well-controlled trials are required to address the relationship of craniofacial and upper airway morphology to pediatric sleep-disordered breathing in all 3 dimensions.

Topics: Adenoids; Adolescent; Cephalometry; Child; Child, Preschool; Humans; Hypertrophy; Infant; Larynx; Likelihood Functions; Nose; Pharynx; Sleep Apnea Syndromes; Sleep Apnea, Obstructive

Positive airway pressure can be effective for OSA treatment but is not effectively used by many patients. Surgical reconstruction of the airway is appropriate for patients who are not otherwise effectively treated or as first-line treatment for patients with focal airway lesions. For surgical planning, examination schemes of the awake patient, as well as sleep endoscopy may be used. Nasal surgery may facilitate treatment using positive airway pressure or oral appliances or to improve quality of life. Pharyngoplasty and tongue base techniques for therapeutic upper airway reconstruction may be performed staged or simultaneously. Current and future approaches are described.

Topics: Endoscopy; Glossectomy; Humans; Macroglossia; Nasal Obstruction; Nose; Palate, Soft; Perioperative Care; Pharynx; Rhinoplasty; Sleep Apnea, Obstructive; Tonsillectomy

Over the last several decades, various surgical treatments have been advocated and used to treat obstructive sleep apnea. Treatments ranging from aggressive procedures, such as tracheostomy, to the least-invasive procedures, such as radioablation, have not yielded satisfactory results. One of the major causes for surgical failures and lower success rates lies in the inadequate understanding and appreciation of the anatomic and pathophysiologic factors that contribute to upper airway obstruction. In some cases, combinations of various surgical techniques may help improve the conditions. This article reviews several major types of surgical procedures, their complications, and the recommended approaches for retreatments.

Topics: Airway Obstruction; Catheter Ablation; Humans; Laser Therapy; Mandibular Advancement; Nose; Palate; Patient Care Planning; Patient Selection; Postoperative Complications; Prostheses and Implants; Reoperation; Risk Factors; Sleep Apnea, Obstructive; Surgical Flaps; Tracheostomy; Uvula

Snoring and obstructive sleep apnoea are both due to multilevel anatomical obstruction, and the nose and nasal pathology both contribute in many cases. This paper addresses some of the issues surrounding the problem and briefly discusses the role of medication and nasal dilators and in more detail the implication of nasal surgery in various aspects of sleep related breathing disorders (SRBD). Nasal obstruction leads to mouth breathing, which destabilises the upper airway and aggravates SRBD.

Topics: Continuous Positive Airway Pressure; Humans; Nose; Quality of Life; Rhinitis, Allergic, Perennial; Sleep Apnea, Obstructive; Sleep Wake Disorders; Snoring

Obstructive sleep apnoea syndrome (OSAS) is a prevalent condition that covaries with cardiovascular complications and most likely with arterial hypertension and diabetes mellitus.. The present paper is a review of the current status of OSAS.. Definitions and diagnostic criteria as well as known risk factors, prevalence, symptoms, covariance with other diseases and consequences as traffic accidents are described. OSAS is characterised by daytime sleepiness symptoms that range from mild to severe. Risk factors such as anatomical upper airway abnormalities, overweight, smoking, excessive alcohol intake and use of muscle relaxants are related to the development of sleep apnoea. Various diagnostic procedures and treatment modalities are considered. Overnight polysomnography is the reference standard for sleep apnoea recording. Treatment modalities include mechanical [continuous positive airway pressure (CPAP), oral appliances], surgical, pharmacological and 'conservative' lifestyle modifications. Finally, Nordic accreditation guidelines for sleep medicine clinics and sleep medicine specialists are described.. The diagnosis of OSAS should be performed with a polygraph, and the first-line treatment of moderate to severe OSAS is CPAP. Lastly, compliance for this treatment should be optimised with regular clinical controls.

Topics: Combined Modality Therapy; Continuous Positive Airway Pressure; Female; Humans; Life Style; Male; Nasal Obstruction; Nose; Orthodontic Appliances; Pharynx; Polysomnography; Prevalence; Prognosis; Risk Assessment; Severity of Illness Index; Sleep Apnea, Obstructive; Surgical Procedures, Operative; Treatment Outcome; Weight Loss

Upper airway surgery is an important treatment option for patients with obstructive sleep apnea (OSA), particularly for those who have failed or cannot tolerate positive airway pressure therapy. Surgery aims to reduce anatomical upper airway obstruction in the nose, oropharynx, and hypopharynx. Procedures addressing nasal obstruction include septoplasty, turbinectomy, and radiofrequency ablation (RF) of the turbinates. Surgical procedures to reduce soft palate redundancy include uvulopalatopharyngoplasty, uvulopalatal flap, laser-assisted uvulopalatoplasty, and RF of the soft palate with adenotonsillectomy. More significant, however, particularly in cases of severe OSA, is hypopharyngeal or retrolingual obstruction related to an enlarged tongue, or more commonly due to maxillomandibular deficiency. Surgeries in these cases are aimed at reducing the bulk of the tongue base or providing more space for the tongue in the oropharynx so as to limit posterior collapse during sleep. These procedures include genioglossal advancement, hyoid suspension, distraction osteogenesis, tongue RF, lingualplasty, and maxillomandibular advancement. Successful surgery depends on proper patient selection, proper procedure selection, and experience of the surgeon. Most surgeries are done in combination and in a multistep manner, with maxillomandibular advancement typically being reserved for refractory or severe OSA, or for those with obvious and significant maxillomandibular deficiency. Although not without risks and not as predictable as positive airway pressure therapy, surgery remains an important therapeutic consideration in all patients with OSA. Current research aims to optimize the success of these procedures by identifying proper candidates for surgery, as well as to develop new invasive procedures for OSA treatment.

Topics: Clinical Competence; Humans; Larynx; Mandible; Maxilla; Nose; Patient Selection; Pharynx; Postoperative Complications; Sleep Apnea, Obstructive

Data from observational studies suggest that nasal obstruction contributes to the pathogenesis of snoring and obstructive sleep apnoea (OSA). To define more accurately the relationship between snoring, OSA and nasal obstruction, the current authors have summarised the literature on epidemiological and physiological studies, and performed a systematic review of randomised controlled trials in which the effects of treating nasal obstruction on snoring and OSA were investigated. Searches of bibliographical databases revealed nine trials with randomised controlled design. External nasal dilators were used in five studies, topically applied steroids in one, nasal decongestants in two, and surgical treatment in one study. Data from studies using nasal dilators, intranasal steroids and decongestants to relieve nasal congestion showed beneficial effects on sleep architecture, but only minor improvement of OSA symptoms or severity. Snoring seemed to be reduced by nasal dilators. Nasal surgery also had minimal impact on OSA symptoms. In conclusion, chronic nasal obstruction seems to play a minor role in the pathogenesis of obstructive sleep apnoea, and seems to be of some relevance in the origin of snoring. The impact of treating nasal obstruction in patients with snoring and obstructive sleep apnoea on long-term outcome remains to be defined through randomised controlled trials of medical and surgical therapies.

Topics: Humans; Nose; Randomized Controlled Trials as Topic; Sleep Apnea, Obstructive; Snoring

Obstructive sleep apnea syndrome (OSAS) is characterized by the development of repeated episodes of pharyngeal collapse. Respiratory movements attempt to reopen the closed pharynx leading to resumption of ventilation associated with micro-arousals. Three kinds of measurements are needed to establish the diagnosis of OSAS: airflow (reduction or complete interruption), respiratory effort in response to increased airway resistance, micro-arousals associated with the end of the respiratory event. Classically, polysomnography was used to establish sleep architecture using electroencephalography, electromyography and electro-oculography. Air flow was measured by thermistors, chest and abdominal movements and oximetry were monitored. Other more accessible methods can also be used to establish reliable diagnosis. Measuring pulse transit time using ECG and oximeter sensors provide a semi-quantitative measurement of respiratory effort. Likewise, cardiovascular markers (heart rate, blood pressure, pulse time) can be used instead of electroencephalography to establish the arousal pattern. Cardiovascular markers are as sensitive and probably as specific as EEG for identifying micro-arousals. Measuring nasal pressure provides a much less invasive quantitative assessment of airflow than pneumotachography. The shape of the inspiratory signal is also an indirect marker of respiratory effort. These new tools can be used to characterize the three elementary abnormalities observed in OSAS: variations in airflow, increased respiratory effort, fragmented sleep, using a very simplified setting compared with classical techniques. Therapeutic monitoring of OSAS patients, particularly after surgery, should not be limited to physical examination known to lack sufficient sensitivity. It should also include simplified methods or complete polysomnography to obtain a precise measurement of residual respiratory events and sleep pattern after treatment.

Topics: Air Pressure; Airway Resistance; Arousal; Electrocardiography; Humans; Mandibular Advancement; Nose; Occlusal Splints; Outcome Assessment, Health Care; Oximetry; Polysomnography; Pulmonary Ventilation; Pulse; Sleep Apnea, Obstructive; Work of Breathing

Surgery has long been a therapeutic option for obstructive sleep apnea syndrome (OSAS). The first procedures targeted the soft palate but results of isolated uvulo-palatopharyngoplasty (UPPP) were inconstant. A better understanding of the mechanisms involved in pharyngeal collapse incited interest in the role of the tongue and the retropharyngeal space. Surgical procedures were then developed for this level of the upper airways. There are a large number of possibilities. Excepting tracheostomy which court-circuits the collapsed zone, all the other procedures are designed to widen more or less one or more of the upper airway levels. The target can be the nose, the soft palate or the tongue, alone or in combinations. In all cases, the surgical alternative should be balanced against a non-invasive option: continuous positive pressure ventilation. The objective is to minimize the operative risks and sequelae while assuring success equivalent to positive pressure ventilation. It is important to note that sufficiently effective and permanent results have not been proven for any surgical technique, excepting tracheostomy and to a lesser degree bimaxillary advancement osteotomy, due to the lack of objective long-term rigorous evaluation. A considerable effort must be made in this domain.

Topics: Humans; Mandibular Advancement; Nose; Oral Surgical Procedures; Osteotomy; Palate, Soft; Pharynx; Sleep Apnea, Obstructive; Tongue; Tracheostomy

The role of the nasal passage in the pathophysiology of obstructive sleep apnea (OSA) is still controversial. To this end, induction of acute nasal obstruction in healthy volunteers is associated with sleep fragmentation and an increase in the number of obstructive and central apneas. Moreover, nasal topical anesthesia, which alters nasal reflexes, is associated with an increase in the number of obstructive and central apneas during sleep. Although nasal resistance is increased in patients with OSA, chronic nasal obstruction appears to play no significant role in the genesis, maintenance, or severity of OSA. Moreover, surgical correction of nasal obstruction does not alleviate OSA appreciably. The purpose of this review is to outline the current body of knowledge on the pathophysiology, diagnosis, and treatment of nasal obstruction in patients with OSA.

Topics: Female; Humans; Male; Nasal Obstruction; Nose; Respiratory Mechanics; Sleep Apnea, Obstructive

We hypothesize that the control of tongue position using a newly developed tongue position retainer, where the tongue is held in a protruded position (i.e., intervention A) or in its resting position (i.e., intervention B), is effective for maintaining upper airway patency in obstructive sleep apnea (OSA) compared with no control of tongue position. This is a randomized, controlled, non-blinded, crossover, and two-armed trial (i.e., sequence AB/BA) in 26 male participants (i.e., sample size) who are scheduled to undergo a dental operation under intravenous sedation with OSA (10 ≤ respiratory event index < 30/h). Participants will be randomly allocated into either sequence by a permuted block method, stratified by body mass index. Under intravenous sedation, participants will undergo two interventions, separated by a washout period after receiving intervention A or intervention B using a tongue position retainer after baseline evaluation, before each intervention is provided. The primary outcome is the abnormal breathing index of apnea as determined by the frequency of apnea per hour. We expect that, compared with no control of tongue position, both intervention A and intervention B will improve the abnormal breathing events with superior effects achieved by the former, offering a therapeutic option for OSA.

Topics: Cross-Over Studies; Humans; Male; Nose; Randomized Controlled Trials as Topic; Sleep Apnea, Obstructive; Tongue

To compare the effects of mandibular advancement device (MAD) therapy on upper airway dimensions between responders and non-responders with mild to moderate obstructive sleep apnea (OSA).. Thirty-one participants (21 men and 10 women) with a mean ± SD apnea-hypopnea index (AHI) of 16.6 ± 6.7 events/h, and aged 48.5 ± 13.9 years, were included in this study. Polysomnographic recordings and cone beam computed tomography (CBCT) scans in supine position were performed for every participant at baseline and at 3-month follow-up with their MAD in situ. Responders were defined as having ≥ 50% reduction in baseline AHI with a residual AHI < 10 events/h. The primary outcome variable was the minimal cross-sectional area of the upper airway (CSAmin).. No significant differences were found between responders (n = 15) and non-responders (n = 16) in age, gender distribution, body mass index, and neck circumference (P = 0.06-0.93), nor in AHI and CSAmin (P = 0.40 and 0.65, respectively) at baseline. The changes of the CSAmin with MAD in situ in the responder group were not significantly different compared to those in the non-responder group (P = 0.06).. Within the limitations of this study, we conclude that the changes of the upper airway dimensions induced by MADs are not significantly different between responders and non-responders with mild to moderate OSA.. ClinicalTrials.gov Identifier: NCT02724865. https://clinicaltrials.gov/ct2/show/NCT02724865.

Topics: Adult; Body Mass Index; Cone-Beam Computed Tomography; Female; Humans; Male; Middle Aged; Nose; Occlusal Splints; Sleep Apnea, Obstructive

Recent findings indicate that noradrenergic and antimuscarinic processes are crucial for sleep-related reductions in pharyngeal muscle activity. However, there are few human studies. Accordingly, this study aimed to determine if a combined noradrenergic and antimuscarinic intervention increases pharyngeal dilator muscle activity and improves airway function in sleeping humans.. Genioglossus (GG) and tensor palatini electromyography (EMG), pharyngeal pressure, upper airway resistance, and breathing parameters were acquired in 10 healthy adults (5 female) during two overnight sleep studies after 4 mg of reboxetine (REB) plus 20 mg of hyoscine butylbromide (HBB) or placebo using a double-blind, placebo-controlled, randomized, cross-over design.. Compared with placebo, peak and tonic GG EMG were lower (Mean ± SD: 83 ± 73 vs. 130 ± 75, p = 0.021 and 102 ± 102 vs. 147 ± 123 % wakefulness, p = 0.021, respectively) but the sleep-related reduction in tensor palatini was less (Median [25th, 75th centiles]: 53[45, 62] vs. 34[28, 38] % wakefulness, p = 0.008) with the drug combination during nonrapid eye movement (non-REM) sleep. These changes were accompanied by improved upper airway function including reduced pharyngeal pressure swings, airway resistance, respiratory load compensation, and increased breathing frequency during N2. REB and HBB significantly reduced rapid eye movement sleep compared with placebo (0.6 ± 1.1 vs. 14.5 ± 6.8 % total sleep time, p < 0.001).. Contrary to our hypothesis, GG muscle activity (% wakefulness) during non-REM sleep was lower with REB and HBB. However, sleep-related reductions in tensor palatini activity were less and upper airway function improved. These findings provide mechanistic insight into the role of noradrenergic and antimuscarinic processes on upper airway function in humans and have therapeutic potential for obstructive sleep apnea.. Australian New Zealand Clinical Trials Registry, https://www.anzctr.org.au, trial ID: ACTRN12616000469415.

Topics: Adult; Airway Resistance; Australia; Butylscopolammonium Bromide; Cross-Over Studies; Double-Blind Method; Electromyography; Female; Humans; Male; Nose; Parasympatholytics; Pharyngeal Muscles; Pharynx; Polysomnography; Pressure; Reboxetine; Respiration; Scopolamine; Sleep; Sleep Apnea, Obstructive; Sleep, REM; Tongue; Wakefulness

Evidence for the management of CPAP-treated obstructive sleep apnea suggests that oronasal masks reduce mouth leaks at the expense of higher pressures and poorer adherence. Some authors have proposed the use of mandibular advancement devices in combination with nasal masks to address this. The aim of this study was to assess adherence to CPAP after 1 month's use of a nasal mask with a mandibular advancement device and to compare adherence with an oronasal mask.. A randomized crossover trial design to assess whether a mandibular advancement device combined with a nasal mask would improve CPAP adherence compared to an oronasal mask.. There was no improvement in CPAP adherence and self-reported interface-related pain was significantly higher with the combined treatment.. Although the combined treatment reduced pressures, likely by improving upper airway patency, it may only be appropriate for a small number of patients due to associated discomfort.. NCT01889472.

Topics: Adult; Continuous Positive Airway Pressure; Cross-Over Studies; Equipment and Supplies; Female; Humans; Male; Mandibular Advancement; Masks; Middle Aged; Nose; Patient Compliance; Sleep Apnea, Obstructive

Patient interface is important for the success of continuous positive airway pressure (CPAP), but few trials have examined the influence of mask choice on CPAP adherence.. To compare the impact of different nasal masks on CPAP in patients with newly-diagnosed obstructive sleep apnea (OSA).. OSA patients were randomized in a 2:3 ratio to receive CPAP via different first-line nasal masks: ResMed Mirage FX® (MFX) or control mask (Fisher & Paykel Zest. Of 285 randomized patients, 90 requiring a full-face mask were excluded, leaving 195 and 151 in the mITT and OT analyses, respectively. Mask acceptance rate was higher in the MFX versus control group (mITT: 79% vs 68%, P = 0.067; OT: 90% vs 76%, P = 0.022). CPAP compliance was higher (5.9 ± 1.8 vs 5.1 ± 1.6 h/night, P = 0.011) and nasal mask issue-related HCP visits lower (3% vs 17%, P = 0.006) in the MFX group. Nasal mask failures due to mask discomfort (5% vs 1%) or unintentional leakage (5% vs 0%) were higher in control vs MFX group. Mask acceptance was significantly associated with fewer mask leaks (P = 0.002) and higher pressure therapy (P = 0.042).. This study highlights differences between nasal masks for CPAP delivery and shows that initial mask selection can influence adherence and healthcare utilization during CPAP.

Topics: Adult; Aged; Continuous Positive Airway Pressure; Delivery of Health Care; Equipment Design; Female; Humans; Male; Masks; Middle Aged; Nose; Outcome Assessment, Health Care; Patient Compliance; Patient Satisfaction; Prospective Studies; Sleep Apnea, Obstructive

The aim of this study was to evaluate the effects of nasal dilator strip (NDS) as a placebo intervention compared with continuous positive airway pressure (CPAP) treatment in patients with severe obstructive sleep apnea (OSA).. Patients were treated with both NDS and nasal CPAP. The sequence was randomized and interposed by 15 days of washout. Polysomnography was performed at baseline and on the first night of intervention with NDS and CPAP (titration). The Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ), and Beck Depression Inventory (BDI) were completed at baseline and at the end of both interventions. A questionnaire on the comfort and satisfaction (0 = no to 10 = total) was completed at the end of each intervention.. Our data indicate that NDS is an attractive placebo intervention for randomized controlled trials evaluating the effects of CPAP in sleepy patients with OSA.

Topics: Brazil; Continuous Positive Airway Pressure; Cross-Over Studies; Female; Humans; Male; Middle Aged; Nose; Patient Compliance; Patient Satisfaction; Placebos; Polysomnography; Sleep Apnea, Obstructive; Treatment Outcome

Selective upper airway stimulation (sUAS) of the hypoglossal nerve is a useful therapy to treat patients with obstructive sleep apnea. Is it known that multiple obstructions can be solved by this stimulation technique, even at the retropalatal region. The aim of this study was to verify the palatoglossus coupling at the soft palate during stimulation.. Single-center, prospective clinical trail.. Twenty patients who received an sUAS implant from April 2015 to April 2016 were included. A drug-induced sedated endoscopy (DISE) was performed before surgery. Six to 12 months after activation of the system, patients' tongue motions were recorded, an awake transnasal endoscopy was performed with stimulation turned on, and a DISE with stimulation off and on was done.. Patients with a bilateral protrusion of the tongue base showed a significantly increased opening at the retropalatal level compared to ipsilateral protrusions. Furthermore, patients with a clear activation of the geniohyoid muscle showed a better reduction in apnea-hypopnea index.. A bilateral protrusion of the tongue base during sUAS seems to be accompanied with a better opening of the soft palate. This effect can be explained by the palatoglossal coupling, due to its linkage of the muscles within the soft palate to those of the lateral tongue body.. 4 Laryngoscope, 127:E378-E383, 2017.

Topics: Aged; Electric Stimulation Therapy; Excitation Contraction Coupling; Humans; Hypoglossal Nerve; Male; Middle Aged; Natural Orifice Endoscopic Surgery; Nose; Palatal Muscles; Palate, Soft; Prospective Studies; Prosthesis Implantation; Sleep Apnea, Obstructive; Tongue; Treatment Outcome

Upper-airway stimulation (UAS) using a unilateral implantable neurostimulator for the hypoglossal nerve is an effective therapy for obstructive sleep apnoea patients with continuous positive airway pressure intolerance. This study evaluated stimulation effects on retropalatal and retrolingual dimensions during drug-induced sedation compared with wakefulness to assess mechanistic relationships in response to UAS. Patients with an implanted stimulator underwent nasal video endoscopy while awake and/or during drug-induced sedation in the supine position. The cross-sectional area, anterior-posterior and lateral dimensions of the retropalatal and retrolingual regions were measured during baseline and stimulation. 15 patients underwent endoscopy while awake and 12 underwent drug-induced sedation endoscopy. Increased levels of stimulation were associated with increased area of both the retropalatal and retrolingual regions. During wakefulness, a therapeutic level of stimulation increased the retropalatal area by 56.4% (p=0.002) and retrolingual area by 184.1% (p=0.006). During stimulation, the retropalatal area enlarged in the anterior-posterior dimension while retrolingual area enlarged in both anterior-posterior and lateral dimensions. During drug-induced sedation endoscopy, the same stimulation increased the retropalatal area by 180.0% (p=0.002) and retrolingual area by 130.1% (p=0.008). Therapy responders had larger retropalatal enlargement with stimulation than nonresponders. UAS increases both the retropalatal and retrolingual areas. This multilevel enlargement may explain reductions of the apnoea-hypopnoea index in selected patients receiving this therapy.

Topics: Adult; Endoscopy; Humans; Hypoglossal Nerve; Image Processing, Computer-Assisted; Implantable Neurostimulators; Male; Middle Aged; Nose; Pharynx; Polysomnography; Prospective Studies; Respiratory System; Sleep Apnea, Obstructive; Video Recording; Wakefulness

Patients with obstructive sleep apnea may stop breathing momentarily during sleep because of a narrow upper respiratory tract. One of the main treatments for obstructive sleep apnea is continuous positive airway pressure. However, after long-term treatment, patients tend to complain about the leakage, inconvenience, and discomfort of the nasal mask.. The purpose of the study was to develop customized cushions and compare the clinical performance of the customized cushion with the conventional one.. Each participant's face was replicated by using a 3-dimensional scanner and reverse-engineering technology, and computer numerical control techniques were used to design and manufacture customized cushions. Forty participants were randomly divided into 2 groups, a control group with conventional cushions and an experimental group with customized cushions. The saturation level of peripheral oxygen, apnea-hypopnea index, leakage data, and answers to a comfort questionnaire were examined.. Customized and conventional cushions were compared with independent sampling t tests and relational analyses. A significant difference was found in the apnea-hypopnea index (P=.001) of participants with the customized cushion and those with the conventional cushion. Participants with the conventional cushion had a lower apnea-hypopnea index. The customized cushion applied less headgear force and fit better than the conventional cushion. The leakage volume, saturation of peripheral oxygen (SpO2), treatment compliance, and degree of comfort were not significantly different between the groups.. Customized nasal mask cushions fit better and reduce the force applied by the headgear. Participants using a customized cushion showed an improved apnea-hypopnea index.

Topics: Biocompatible Materials; Computer-Aided Design; Continuous Positive Airway Pressure; Equipment Design; Equipment Failure; Face; Female; Humans; Imaging, Three-Dimensional; Male; Masks; Middle Aged; Nose; Oximetry; Oxygen; Patient Compliance; Patient Satisfaction; Photography; Silicones; Sleep Apnea, Obstructive; Stress, Mechanical; Surface Properties

Unlike other prevalent diseases, obstructive sleep apnea (OSA) has no simple tool for diagnosis and therapeutic decision-making in primary healthcare. Home single-channel nasal pressure (HNP) may be an alternative to polysomnography for diagnosis but its use in therapeutic decisions has yet to be explored.. To ascertain whether an automatically scored HNP apnea-hypopnea index (AHI), used alone to recommend continuous positive airway pressure (CPAP) treatment, agrees with decisions made by a specialist using polysomnography and several clinical variables.. Patients referred by primary care physicians for OSA suspicion underwent randomized polysomnography and HNP. We analyzed the total sample and both more and less symptomatic subgroups for Bland and Altman plots to explore AHI agreement; receiver operating characteristic curves to establish area under the curve (AUC) measurements for CPAP recommendation; and therapeutic decision efficacy for several HNP AHI cutoff points.. Of the 787 randomized patients, 35 (4%) were lost, 378 (48%) formed the more symptomatic and 374 (48%) the less symptomatic subgroups. AHI bias and agreement limits were 5.8 ± 39.6 for the total sample, 5.3 ± 38.7 for the more symptomatic, and 6 ± 40.2 for the less symptomatic subgroups. The AUC were 0.826 for the total sample, 0.903 for the more symptomatic, and 0.772 for the less symptomatic subgroups. In the more symptomatic subgroup, 70% of patients could be correctly treated with CPAP.. Automatic HNP scoring can correctly recommend CPAP treatment in most of more symptomatic patients with OSA suspicion. Our results suggest that this device may be an interesting tool in initial OSA management for primary care physicians, although future studies in a primary care setting are necessary.. Clinicaltrial.gov identifier: NCT01347398.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Area Under Curve; Continuous Positive Airway Pressure; Female; Humans; Male; Middle Aged; Nose; Polysomnography; Pressure; ROC Curve; Sleep Apnea, Obstructive; Young Adult

Home single-channel nasal pressure (HNP) may be an alternative to polysomnography (PSG) for obstructive sleep apnea (OSA) diagnosis, but no cost studies have yet been carried out. Automatic scoring is simpler but generally less effective than manual scoring.. To determine the diagnostic efficacy and cost of both scorings (automatic and manual) compared with PSG, taking as a polysomnographic OSA diagnosis several apnea-hypopnea index (AHI) cutoff points.. We included suspected OSA patients in a multicenter study. They were randomized to home and hospital protocols. We constructed receiver operating characteristic (ROC) curves for both scorings. Diagnostic efficacy was explored for several HNP AHI cutoff points, and costs were calculated for equally effective alternatives.. Of 787 randomized patients, 752 underwent HNP. Manual scoring produced better ROC curves than automatic for AHI < 15; similar curves were obtained for AHI ≥ 15. A valid HNP with manual scoring would determine the presence of OSA (or otherwise) in 90% of patients with a polysomnographic AHI ≥ 5 cutoff point, in 74% of patients with a polysomnographic AHI ≥ 10 cutoff point, and in 61% of patients with a polysomnographic AHI ≥ 15 cutoff point. In the same way, a valid HNP with automatic scoring would determine the presence of OSA (or otherwise) in 73% of patients with a polysomnographic AHI ≥ 5 cutoff point, in 64% of patients with a polysomnographic AHI ≥ 10 cutoff point, and in 57% of patients with a polysomnographic AHI ≥ 15 cutoff point. The costs of either HNP approaches were 40% to 70% lower than those of PSG at the same level of diagnostic efficacy. Manual HNP had the lowest cost for low polysomnographic AHI levels (≥ 5 and ≥ 10), and manual and automatic scorings had similar costs for higher polysomnographic cutoff points (AHI ≥ 15) of diagnosis.. Home single-channel nasal pressure (HNP) is a cheaper alternative than polysomnography for obstructive sleep apnea diagnosis. HNP with manual scoring seems to have better diagnostic accuracy and a lower cost than automatic scoring for patients with low apnea-hypopnea index (AHI) levels, although automatic scoring has similar diagnostic accuracy and cost as manual scoring for intermediate and high AHI levels. Therefore, automatic scoring can be appropriately used, although diagnostic efficacy could improve if we carried out manual scoring on patients with AHI < 15.. Clinicaltrials.gov identifier: NCT01347398.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Costs and Cost Analysis; Female; Humans; Male; Middle Aged; Nose; Polysomnography; Pressure; ROC Curve; Sleep Apnea, Obstructive; Young Adult

The aim of this study was to test the effectiveness of Provent, an expiratory nasal resistance valve, to prevent the recurrence of OSA following CPAP withdrawal.. Randomised, partially blinded, parallel, placebo-controlled trial.. Outpatient sleep clinics in the UK (Oxford) and Switzerland (Zurich).. 67 patients with OSA receiving CPAP were randomised to one of three groups for 2 weeks: continuing CPAP, Provent or placebo Provent.. Primary outcomes included for Provent versus placebo Provent, OSA severity (oxygen desaturation index (ODI), apnoea-hypopnoea index (AHI)) and Epworth Sleepiness Scale (ESS) score. Secondary outcomes for Provent versus placebo Provent included ODI from ambulatory pulse oximetry and blood pressure (BP). For CPAP versus Provent, or CPAP versus placebo Provent, secondary outcomes included ODI/AHI, ESS and BP.. 63 patients were included in the per protocol analysis. OSA recurred in the Provent (ODI 35.8, SD 17.4) and placebo Provent (ODI 28.2, SD 18.3) groups, and there was no significant difference in ODI, AHI and ESS between Provent and placebo Provent at 2 weeks (mean difference ODI -1.0, 95% CI -10.0 to +12.0, p=0.85; AHI +3.2, 95% CI -7.7 to +14.1, p=0.52; and ESS -1.4, 95% CI -4.1 to +1.4, p=0.33). ODI from ambulatory pulse-oximetry and BP at 2 weeks were not different in the Provent versus placebo Provent groups. ODI, AHI and BP, but not ESS, were significantly higher in the Provent and placebo Provent groups compared with CPAP.. Provent cannot be recommended as an alternative short-term therapy for patients with moderate to severe OSA already on CPAP.. NCT01332175.

Topics: Aged; Blood Pressure; Continuous Positive Airway Pressure; Disorders of Excessive Somnolence; Female; Humans; Male; Middle Aged; Nose; Oximetry; Oxygen; Polysomnography; Prostheses and Implants; Recurrence; Severity of Illness Index; Sleep Apnea, Obstructive; Surveys and Questionnaires; Withholding Treatment

Compliance with CPAP therapy remains an issue despite its effectiveness. Mask selection is likely to affect a patients experience with CPAP, and multiple mask options are currently available. Nasal pillows have less contact with the face compared to nasal masks and may benefit patients by minimizing side effects; however, they are infrequently used at high CPAP pressures. The aim of this study was to examine the performance of nasal pillows at pressures ≥ 12 cm H2O compared with nasal masks.. Twenty-one subjects were recruited. Participants were randomized to Swift FX nasal pillows and their current nasal mask for 7 consecutive nights each in a prospective crossover trial. Objective device data and subjective feedback were collected.. There were no differences in objective device data of nasal pillows vs. nasal masks: Daily Usage 7.4 ± 1.4 vs. 7.2 ± 1.4 (h/night); 95(th)%ile Leak 28.6 ± 13.5 vs. 27.9 ± 17.9 (L/min); AHI 1.9 ± 1.3 vs. 1.7 ± 1.1, respectively (all p-values > 0.05). There were no differences between the nasal pillows and nasal masks for subjective ratings of comfort, seal, red marks, side effects such as jetting and dry nose/mouth, and overall performance (all p-values > 0.05). The nasal pillows were rated to be less obtrusive and claustrophobic (both p-values < 0.01), but less stable (p = 0.04). Overall preference was 50% nasal pillows, 45% nasal masks; 5% found no difference.. Nasal pillows are as efficacious as nasal masks at CPAP pressures ≥ 12 cm H2O and are a suitable option for patients requiring high CPAP pressures.. NIH Clinical Trials Registry. http://clinicaltrials.gov.. Nasal Pillows at High CPAP Pressure. Identifier: NCT01690923.

Topics: Continuous Positive Airway Pressure; Cross-Over Studies; Female; Humans; Male; Middle Aged; Nose; Patient Preference; Sleep Apnea, Obstructive; Treatment Outcome

Although there is a strong correlation between oral/oro-nasal breathing and apnoea/hypopnoea index in patients with obstructive sleep apnoea and normal nasal resistance at wakefulness, it remains unknown whether the pharmacological prevention of potential nasal obstruction during sleep could decrease oral/oro-nasal breathing and increase nasal breathing and subsequently decrease the apnoea/hypopnoea index. This study evaluated the effect of a combination of a nasal decongestant with corticosteroid on breathing route pattern and apnoea/hypopnoea index. 21 patients with obstructive sleep apnoea (mean apnoea/hypopnoea index 31.1 events per hour) and normal nasal resistance at wakefulness were enrolled in a randomised crossover trial of 1 weeks' treatment with nasal tramazoline and dexamethasone compared with 1 weeks' treatment with nasal placebo. At the start and end of each treatment period, patients underwent nasal resistance measurement and overnight polysomnography with attendant measurement of breathing route pattern. Nasal tramazoline with dexamethasone was associated with decrease in oral/oro-nasal breathing epochs and concomitant increase in nasal breathing epochs, and mean decrease of apnoea/hypopnoea index by 21%. The change in nasal breathing epochs was inversely related to the change in apnoea/hypopnoea index (Rs=0.78; p<0.001). In conclusion, nasal tramazoline with dexamethasone in OSA patients with normal nasal resistance at wakefulness can restore the preponderance of nasal breathing epochs and modestly improve apnoea/hypopnoea index.

Topics: Adult; Anthropometry; Body Mass Index; Cross-Over Studies; Dexamethasone; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Imidazoles; Male; Manometry; Nose; Polysomnography; Respiration; Sleep Apnea, Obstructive; Wakefulness

Both obstructive sleep apnea syndrome (OSAS) and panic disorder (PD) are common disorders that often coexist. Continuous positive airway pressure (CPAP) has been established as the first-line treatment for OSAS. In this study, we examined the efficacy of CPAP on PD comorbid with OSAS by conducting a randomized crossover study using sham CPAP as control.. PD patients (n=12) with an apnea hypopnea index (AHI) of 20/h or higher completed the study. At baseline, the subjects were asked to write their own records pertaining to the frequency of attacks and their score on the panic disorder severity scale (PDSS), and then they participated in the randomized crossover trial period, which measured optimal CPAP and sham CPAP set at 4cmH(2)O during nighttime sleep for each 4-week assignment.. The frequency of panic attacks, total PDSS score, and the frequency of alprazolam use for alleviating the attack symptoms were significantly decreased during the optimal CPAP period than during the baseline period and the sham CPAP period. Among the PDSS subitems, the frequency of attacks, panic distress, work impairment, and social impairment showed significant improvements during the optimal pressure period.. Our results suggest that OSAS contributes to PD aggravation, and a combination of pharmaceutical treatment for PD and OSAS-specific treatments such as CPAP could be recommended for patients with PD comorbid with OSAS.

Topics: Adult; Blood Pressure; Comorbidity; Continuous Positive Airway Pressure; Cross-Over Studies; Female; Humans; Male; Middle Aged; Nose; Panic Disorder; Polysomnography; Severity of Illness Index; Sleep Apnea, Obstructive; Treatment Outcome

To assess the accuracy of novel algorithms using an oximeter-based finger plethysmographic signal in combination with a nasal cannula for the detection and differentiation of central and obstructive apneas. The validity of single pulse oximetry to detect respiratory disturbance events was also studied.. Patients recruited from four sleep laboratories underwent an ambulatory overnight cardiorespiratory polygraphy recording. The nasal flow and photoplethysmographic signals of the recording were analyzed by automated algorithms. The apnea hypopnea index (AHI(auto)) was calculated using both signals, and a respiratory disturbance index (RDI(auto)) was calculated from photoplethysmography alone. Apnea events were classified into obstructive and central types using the oximeter derived pulse wave signal and compared with manual scoring.. Sixty-six subjects (42 males, age 54 ± 14 yrs, body mass index 28.5 ± 5.9 kg/m(2)) were included in the analysis. AHI(manual) (19.4 ± 18.5 events/h) correlated highly significantly with AHI(auto) (19.9 ± 16.5 events/h) and RDI(auto) (20.4 ± 17.2 events/h); the correlation coefficients were r = 0.94 and 0.95, respectively (p < 0.001) with a mean difference of -0.5 ± 6.6 and -1.0 ± 6.1 events/h. The automatic analysis of AHI(auto) and RDI(auto) detected sleep apnea (cutoff AHI(manual) ≥ 15 events/h) with a sensitivity/specificity of 0.90/0.97 and 0.86/0.94, respectively. The automated obstructive/central apnea indices correlated closely with manually scoring (r = 0.87 and 0.95, p < 0.001) with mean difference of -4.3 ± 7.9 and 0.3 ± 1.5 events/h, respectively.. Automatic analysis based on routine pulse oximetry alone may be used to detect sleep disordered breathing with accuracy. In addition, the combination of photoplethysmographic signals with a nasal flow signal provides an accurate distinction between obstructive and central apneic events during sleep.

Topics: Catheterization; Female; Humans; Male; Middle Aged; Nose; Oximetry; Polysomnography; Reproducibility of Results; ROC Curve; Sleep; Sleep Apnea Syndromes; Sleep Apnea, Obstructive

To explore the safe and effective way of nasotracheal intubations in obstructive sleep apnea hypopnea syndrome patients with uvulopalatopharyngoplasty.. Upon the approval of the Ethics Committee at Second Affiliated Hospital of Fujian Medical University, from August 2008 to November 2011, 90 sleep apnea hypopnea syndrome patients were randomly divided into 3 groups (n=30 each): GlideScope (G), fiberoptic bronchoscope (F) and combination of Glidescope with fiberoptic bronchoscope (G+F). The parameters of tracheal intubation time, placement of endotracheal intubation, tracheal injury and complications were recorded. Also systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR) were recorded at post-induction, the moment of tracheal intubation and post-intubation 1, 3, 5 min. Rate pressure product (RPP) was calculated at all time points as the product of heart rate and SBP during observation.. All of them underwent successful endotracheal intubation. There were 24 successful cases of intubation during the first attempt in Group G with a success rate of 80%; 27 patients successful during the first attempt in group F with a success rate of 90%; all in group G+F successful during the first attempt with a success rate of 100%. The rates were significantly different in 3 groups (P<0.05). Groups G and F patients with failed intubation during the first attempt were of Mallampati III/IV. After induction, SBP, DBP, MAP and RPP were lower in 3 groups (P<0.05) while HR change was not obvious. Compared with the after induction, the moment of tracheal intubation and after intubation 1 min, 3 groups of patients with SBP, DBP, MAP, HR and RPP increased (P<0.05). Groups F and G+F after intubation in intubated patients and 1 min of SBP, DBP, MAP, HR, RPP were higher than G group (P<0.05). No difference existed between groups F and G+F. Three groups showed no serious tracheal injury, laryngeal edema, hoarseness or other complications.. During nasotracheal intubation for Mallampati I/II patients, GlideScope offers better overall glottic views. For those of Mallampati III and IV, the combination of Glidescope with fiberoptic bronchoscope may achieve a higher success rate and shorter intubation time than the latter alone.

Topics: Adult; Bronchoscopy; Female; Humans; Intubation, Intratracheal; Laryngoscopes; Male; Middle Aged; Nose; Pharynx; Sleep Apnea, Obstructive

Nasal continuous positive airway pressure (CPAP) can cause undesirable nasal symptoms, such as congestion to obstructive sleep apnoea (OSA) patients, whose symptoms can be attenuated by the addition of heated humidification. However, neither the nature of nasal symptoms nor the effect of heated humidification on nasal pathophysiology and pathology are convincingly known. 20 patients with OSA on nasal CPAP who exhibited symptomatic nasal obstruction were randomised to receive either 3 weeks of CPAP treatment with heated humidification or 3 weeks of CPAP treatment with sham-heated humidification, followed by 3 weeks of the opposite treatment, respectively. Nasal symptom score, nasal resistance, nasal lavage interleukin-6, interleukin-12 and tumour necrosis factor-α and nasal mucosa histopathology were assessed at baseline and after each treatment arm. Heated humidification in comparison with sham-heated humidification was associated with decrease in nasal symptomatology, resistance and lavage cytokines, and attenuation of inflammatory cell infiltration and fibrosis of the nasal mucosa. In conclusion, nasal obstruction of OSA patients on CPAP treatment is inflammatory in origin and the addition of heated humidification decreases nasal resistance and mucosal inflammation.

Topics: Aged; Biopsy; Continuous Positive Airway Pressure; Female; Humans; Humidity; Inflammation; Interleukin-12; Interleukin-6; Male; Middle Aged; Mucous Membrane; Nasal Obstruction; Nose; Sleep Apnea, Obstructive; Time Factors; Treatment Outcome; Tumor Necrosis Factor-alpha

A one-way nasal resistor has recently been shown to reduce sleep disordered breathing (SDB) in a subset of patients with Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS). The purpose of this study was to examine characteristics predictive of therapeutic response to the device and provide pilot data as to its potential mechanisms of action. PATIENTS, INTERVENTIONS, AND MEASUREMENTS: 20 subjects (15M/5F, age 54 ± 12 years, BMI 33.5 ± 5.6 kg/m²) with OSAHS underwent 3 nocturnal polysomnograms (NPSG) including diagnostic, therapeutic (with a Provent® nasal valve device), and CPAP. Additional measurements included intranasal pressures and PCO₂, closing pressures (Pcrit), and awake lung volumes in different body positions.. In 19/20 patients who slept with the device, RDI was significantly reduced with the nasal valve device compared to the diagnostic NPSG (27 ± 29/h vs 49 ± 28/h), with 50% of patients having an acceptable therapeutic response. Among demographic, lung volume, or diagnostic NPSG measures or markers of collapsibility, no significant predictors of therapeutic response were found. There was a suggestion that patients with position-dependent SDB (supine RDI > lateral RDI) were more likely to have an acceptable therapeutic response to the device. Successful elimination of SDB was associated with generation and maintenance of an elevated end expiratory pressure. No single definitive mechanism of action was elucidated.. The present study shows that the nasal valve device can alter SDB across the full spectrum of SDB severity. There was a suggestion that subjects with positional or milder SDB in the lateral position were those most likely to respond.

Topics: Adult; Airway Resistance; Continuous Positive Airway Pressure; Equipment Safety; Exhalation; Female; Humans; Male; Middle Aged; Nose; Pilot Projects; Polysomnography; Posture; Predictive Value of Tests; Prostheses and Implants; Prosthesis Design; Respiratory Function Tests; Sampling Studies; Sleep Apnea, Obstructive; Tidal Volume; Treatment Outcome

To evaluate whether nasal continuous positive airway pressure (nCPAP) reduces oxidative stress in patients with severe obstructive sleep apnea (OSA) syndrome.. Forty-six patients with severe OSA (AHI> or =30) requiring nasal CPAP treatment and 46 controls (subjects without OSA and with mild OSA as defined by an AHI<15) were enrolled. Oxidative stress was evaluated in blood samples with a commercially available automated spectrophotometric assay (D-ROMs test, Diacron, Grosseto, Italy). Blood samples were collected the evening before (10:00 p.m.) and the morning after (07:00 a.m.) a diagnostic polysomnography. Patients with severe OSA syndrome were subsequently submitted to a second polysomnography with nasal CPAP titration the following night. Using the same schedule we collected blood samples from the patients the morning after the nCPAP titration and after two months of nCPAP treatment.. Patients with severe OSA presented higher levels of oxidative stress than patients with AHI<15 in the evening and in the morning (357.57+/-13.07 UCarr vs. 319.28+/-12.66 UCarr, p=0.038, and 371.83+/-12.83 UCarr vs. 328.09+/-11.76 UCarr, p=0.014, respectively). Patients with severe OSA presented a significant reduction the levels of oxidative stress the morning after the nCPAP titration study (371.83+/-12.83 UCarr vs. 298.21+/-9.62 UCarr, p=0.001) and this reduction was further preserved after a period of two months of nCPAP treatment (293.72+/-6.55 UCarr, p=0.001 vs. baseline). Statistically significant correlations were observed between levels of oxidative stress and nocturnal polysomnography (NPSG) markers as oxygen desaturation index (ODI), arousal index (AI), lowest oxygen saturation of hemoglobin, and mean oxygen saturation of hemoglobin.. Patients with severe OSA syndrome presented increased systemic oxidative stress. A single night of nCPAP treatment significantly reduced the levels of oxidative stress in patients with severe OSA syndrome, and this reduction was maintained at least after two months of nCPAP treatment.

Topics: Adult; Continuous Positive Airway Pressure; Female; Follow-Up Studies; Humans; Hydrogen Peroxide; Male; Middle Aged; Nose; Oxidative Stress; Polysomnography; Reactive Oxygen Species; Severity of Illness Index; Sleep Apnea, Obstructive; Treatment Outcome

Although nasal surgery has limited efficacy in obstructive sleep apnoea (OSA) treatment, some patients experience improvement. The present study tested the hypothesis that post-surgery improvement is associated with increased nasal breathing epochs. A total of 49 OSA patients (mean apnoea/hypopnoea index (AHI) 30.1+/-16.3 events x h(-1)) with symptomatic fixed nasal obstruction due to deviated septum were randomly assigned to either septoplasty (surgery group; 27 patients) or sham surgery (placebo group; 22 patients). The breathing route was examined during overnight polysomnography. All patients in the placebo group were nonresponders, whereas in the surgery group four (14.8%) patients were responders and exhibited considerable increase in nasal breathing epochs (epochs containing more than three consecutive phasic nasal signals), and 23 patients were nonresponders, presenting a modest increase in nasal breathing epochs. The change in AHI was inversely related to the change in nasal breathing epochs, with responders exhibiting among the greatest increases in nasal breathing epochs. Baseline nasal breathing epochs were positively related to per cent change in AHI. Responders had among the lowest baseline nasal breathing epochs; a cut-off value of 62.4% of total sleep epochs best separated (100% sensitivity, 82.6% specificity) responders/nonresponders. In conclusion, nasal surgery rarely treats obstructive sleep apnoea effectively. Baseline nasal breathing epochs can predict the surgery outcome.

Topics: Adult; Body Mass Index; Female; Humans; Male; Middle Aged; Nasal Obstruction; Nose; Placebos; Polysomnography; Respiration; Sensitivity and Specificity; Sleep; Sleep Apnea, Obstructive; Treatment Outcome

Nasal operation and/or H-uvulopalatopharyngoplasty (UPPP) was performed for obstructive sleep apnea hypopnea syndrome (OSAHS) patients with both oral pharynx and nasal obstruction, results analyzed.. Patients were divided into group A (46 cases) and group B (42 case) randomly. Nasal procedures were: septoplasty, radiofrequency reduction of inferior turbinate, adenoidectomy and functional endoscopic operation. Cases in group A had nasal operation first, while cases in group B first had UPPP. All patients had sleep study with polysomnography (PSG) 2 and 12 months after each operation. Those who failed to reach the criteria of being effective after first surgery (defined as a 25% reduction in baseline apnea hypopnea index (AHI) received second phase operation (nasal operation for group B and UPPP for group A). The response rates were compared between the two groups after each phase of operation.. In group A, the phase one operation were effective in 44.0% (11/25) for the mild degree OSAHS patients (defined as AHI < 20/h), according to the sleep study performed 2 months after surgery, and no recurrence after one-year. All moderate ones (defined as 20/h < AHI < 40/h) responded poorly to nasal operation. The overall response rate was 23.9% (11/46). Non-responses (35 cases) in group A underwent UPPP and the response rate to it was 85.7% (30/35) in one year. In group B, UPPP operation was effective in 63.6% (14/22) mild cases and 30.0% (6/20) moderate cases in 2 months but 4 cases had recurrence in one year. Twenty-two cases underwent the second phase operation of nose and the response rate was 86.4% (19/22) in one year. There was no statistical significance on the overall response rate between group A and B (89.1% vs 83.3%, P > 0.05). While there was statistical significance of response rate between those patients who had only one operation and those who had both surgeries (P < 0.05).. The combination of nasal procedures and UPPP is effective a for OSAHS patient with nasal diseases especially in mild and moderate cases.

Topics: Adult; Female; Humans; Male; Middle Aged; Nose; Otorhinolaryngologic Surgical Procedures; Palate, Soft; Pharynx; Sleep Apnea, Obstructive; Treatment Outcome; Uvula

To investigate the influence of nasal continual positive airway pressure (nCPAP) on the erectile function of erectile dysfunction (ED) patients with obstructive sleep apnea syndrome(OSAS).. Twenty-seven patients with ED and OSAS were randomly divided into treatment (n = 15) and control (n = 12) groups, the former treated by nCPAP from 22:00 to 6:00 per night for 1 month. And the apnea-hypopnea index(AHI), the lowest oxygen saturation (SaO2) and IIEF were compared before and after treatment.. AHI, the lowest SaO2, erectile function and IIEF showed no significant difference before treatment in the two groups, but displayed a significant improvement after treatment in the treated group compared with the control (P > 0.05), in which no significant changes were observed before and after treatment (P > 0.05).. nCPAP therapy can improve the erectile function of ED patients with OSAS.

Topics: Adult; Aged; Erectile Dysfunction; Humans; Male; Middle Aged; Nose; Positive-Pressure Respiration; Sleep Apnea, Obstructive

There is increasing evidence that obstructive sleep apnea (OSA) is an independent risk factor for arterial hypertension. Because there are no controlled studies showing a substantial effect of nasal continuous positive airway pressure (nCPAP) therapy on hypertension in OSA, the impact of treatment on cardiovascular sequelae has been questioned altogether. Therefore, we studied the effect of nCPAP on arterial hypertension in patients with OSA.. Sixty consecutive patients with moderate to severe OSA were randomly assigned to either effective or subtherapeutic nCPAP for 9 weeks on average. Nocturnal polysomnography and continuous noninvasive blood pressure recording for 19 hours was performed before and with treatment. Thirty two patients, 16 in each group, completed the study. Apneas and hypopneas were reduced by approximately 95% and 50% in the therapeutic and subtherapeutic groups, respectively. Mean arterial blood pressure decreased by 9.9+/-11.4 mm Hg with effective nCPAP treatment, whereas no relevant change occurred with subtherapeutic nCPAP (P=0.01). Mean, diastolic, and systolic blood pressures all decreased significantly by approximately 10 mm Hg, both at night and during the day.. Effective nCPAP treatment in patients with moderate to severe OSA leads to a substantial reduction in both day and night arterial blood pressure. The fact that a 50% reduction in the apnea-hypopnea index did not result in a decrease in blood pressure emphasizes the importance of highly effective treatment. The drop in mean blood pressure by 10 mm Hg would be predicted to reduce coronary heart disease event risk by 37% and stroke risk by 56%.

Topics: Blood Pressure; Female; Humans; Hypertension; Kinetics; Male; Middle Aged; Nose; Polysomnography; Pressure; Sleep Apnea, Obstructive

C-reactive protein (CRP) and interleukin (IL)-6 are important risk factors for atherosclerosis and coronary heart disease. In the present study, we examined serum levels of CRP and IL-6, IL-6 production by monocytes, and the effect of nasal continuous positive airway pressure (nCPAP) in patients with obstructive sleep apnea syndrome (OSAS).. After polysomnography, venous blood was collected at 5 AM from 30 patients with OSAS and 14 obese control subjects. Serum levels of CRP and IL-6 and spontaneous production of IL-6 by monocytes were investigated. In addition, the effects of 1 month of nCPAP were studied in patients with moderate to severe OSAS. Levels of CRP and IL-6 were significantly higher in patients with OSAS than in obese control subjects (CRP P<0.001, IL-6 P<0.05). IL-6 production by monocytes was also higher in patients with OSAS than in obese control subjects (P<0.01). In patients with OSAS, the primary factors influencing levels of CRP were severity of OSAS and body mass index and those influencing levels of IL-6 were body mass index and nocturnal hypoxia. nCPAP significantly decreased levels of both CRP (P<0.0001) and IL-6 (P<0.001) and spontaneous IL-6 production by monocytes (P<0.01).. Levels of CRP and IL-6 and spontaneous production of IL-6 by monocytes are elevated in patients with OSAS but are decreased by nCPAP. Therefore, OSAS is associated with increased risks for cardiovascular morbidity and mortality, and nCPAP may be useful for decreasing these risks.

Topics: C-Reactive Protein; Humans; Interleukin-6; Male; Middle Aged; Monocytes; Nose; Polysomnography; Positive-Pressure Respiration; Sleep Apnea, Obstructive

The aim of this prospective, randomized study was to analyze dental and skeletal side effects after 4 years of treating obstructive sleep apnea (OSA) patients with a mandibular advancement device (MAD) compared with uvulopalatopharyngoplasty (UPPP). With the appliance in position, the mandible was advanced 50% of maximum protrusion capacity (ie, 4-6 mm); the vertical opening between the incisal edges was, on average, 3 mm. Thirty patients in the MAD group and 37 in the UPPP group completed the 4-year follow-up. There were no differences between the MAD and the UPPP groups in any of the dental or skeletal variables measured after the 4-year treatment period. In the MAD group, small but statistically significant changes were found: there was a posterior rotation of the mandible (mandibular line [ML]/nasion-sella line [NSL]) (mean 0.5 degrees [95% confidence interval (CI) 0.1-0.8 degrees ]). Correlated to the posterior rotation of the mandible, the distances incision superius ML, incision superius-NSL, and incision inferius-NSL increased by means (95% CI) of 0.7 (0.5-1.2), 0.8 (0.4-1.1), and 1.3 (0.8-1.8) mm, respectively. Overjet and overbite did not change significantly, nor was there a significant change in the mandibular length. The observed changes were considered clinically insignificant because overbite and overjet stayed within normal limits. Only the vertical position of the maxillary incisors in relation to ML changed to the extent that the 95% CI of the mean for the change was outside that of the mean of the change in the UPPP group and measurement error. Treatment of OSA with a dental appliance is probably a lifelong process, and long-term follow-up studies should therefore be undertaken to control both the treatment effect on OSA and the side effects on the masticatory system.

Topics: Cephalometry; Confidence Intervals; Facial Bones; Follow-Up Studies; Humans; Incisor; Male; Mandible; Mandibular Advancement; Middle Aged; Nose; Orthodontic Appliances; Palate; Pharynx; Prospective Studies; Rotation; Sella Turcica; Sleep Apnea, Obstructive; Statistics, Nonparametric; Tooth; Uvula

Nasal problems are frequent at high continuous positive airway pressure (CPAP). We hypothesized that a reduction of the nasal resistance reduces CPAP and investigated the effect of a nasal valve dilator (Nozovent) on CPAP in patients with obstructive sleep apnea. In a randomized cross-over design Nozovent was inserted in 38 patients during one of two nights using AutoSet T. CPAP differences > 1 cm H2O were considered as clinically relevant. With Nozovent the median CPAP pressure was reduced from 8.6 cm H2O to 8.0 H2O (P = 0.023) in all patients, but the number of patients with a reduction of CPAP by 1 cm H2O was not significant. The median CPAP level among 20 patients requiring a CPAP level of above 9 cm H2O was reduced from 10.3 to 9.1 cm H2O, P < 0.05. A clinical improvement with Nozovent was seen in 10 of 20 patients requiring a pressure of above 9 cm H2O compared with 4 of 18 patients who needed lower pressures, P = 0.025. Nozovent reduces the CPAP level 1 cm H2O in 50% of patients requiring a high pressure (> 9 cm H2O). Future studies should identify possible patients benefiting from a nasal dilator during CPAP therapy.

Topics: Airway Resistance; Cross-Over Studies; Dilatation; Equipment Design; Female; Humans; Laryngeal Masks; Male; Middle Aged; Nose; Polysomnography; Positive-Pressure Respiration; Respiratory Muscles; Sleep Apnea, Obstructive

Healthy subjects with normal nasal resistance breathe almost exclusively through the nose during sleep. This study tested the hypothesis that a mechanical advantage might explain this preponderance of nasal over oral breathing during sleep. A randomised, single-blind, crossover design was used to compare upper airway resistance during sleep in the nasal and oral breathing conditions in 12 (seven male) healthy subjects with normal nasal resistance, aged 30+/-4 (mean+/-SEM) yrs, and with a body mass index of 23+/-1 kg x m2. During wakefulness, upper airway resistance was similar between the oral and nasal breathing routes. However, during sleep (supine, stage two) upper airway resistance was much higher while breathing orally (median 12.4 cmH2O x L(-1) x s(-1), range 4.5-40.2) than nasally (5.2 cmH2O x L(-1) x s(-1), 1.7-10.8). In addition, obstructive (but not central) apnoeas and hypopnoeas were profoundly more frequent when breathing orally (apnoea-hypopnoea index 43+/-6) than nasally (1.5+/-0.5). Upper airway resistance during sleep and the propensity to obstructive sleep apnoea are significantly lower while breathing nasally rather than orally. This mechanical advantage may explain the preponderance of nasal breathing during sleep in normal subjects.

Topics: Adult; Airway Resistance; Cross-Over Studies; Female; Humans; Male; Mouth Breathing; Nose; Single-Blind Method; Sleep; Sleep Apnea, Obstructive; Wakefulness

A bench study using an artificial lung model was performed to evaluate the snoring detection sensitivity of six (commercially available) auto-nasal continuous positive airway pressure (NCPAP) devices. Snoring was simulated by a loudspeaker connected to the lung model and abruptly activated during 1 s of each inspiratory period to induce pressure oscillation. The oscillation frequencies chosen were 30, 60, 90, and 120 Hz. For each frequency, the amplitude of the pressure oscillation produced by the loudspeaker was adjusted to find the threshold at which the auto-nCPAP devices detected snoring. Differences in pressure-amplitude thresholds of up to three-fold were found across auto-nCPAP devices. A randomized clinical study to compare the effects of the least sensitive (Virtuoso LX; Respironics, Nantes, France) and one of the most sensitive, (Goodknight 418A; Malinckrodt, Nancy, France) devices, in two groups of six patients with obstructive sleep apnoea syndrome was then conducted. Goodknight 418A was more sensitive than Virtuoso LX for detecting snoring (mean +/- SD 92 +/- 11% versus 50 +/- 39% respectively, p = 0.03). To conclude, striking differences exist between auto-nasal continuous positive airway pressure devices in sensitivity for detecting snoring.

Topics: Humans; Middle Aged; Models, Theoretical; Nose; Positive-Pressure Respiration; Sleep Apnea, Obstructive; Snoring

To measure the readjustments of sleep macro- and microstructure in patients with obstructive sleep apnea syndrome (OSAS) after acute nasal continuous positive airway pressure (NCPAP) treatment.. The conventional polysomnographic analysis (macrostructure of sleep) does not necessarily provide the best measures of sleep disruption associated with OSAS. In contrast, microstructural methods of analyzing sleep (i.e., arousals and cyclic alternating pattern) may improve evaluation of patients with OSAS.. - Ten patients with OSAS were monitored polygraphically before and during the first night of NCPAP therapy. The results were compared with those of 10 age- and sex-matched controls without sleep-related breathing disorders. Each nocturnal recording was followed by daytime observation using the multiple sleep latency test and Visual Analogue Scale (VAS).. The first night of ventilatory therapy was characterized by a remarkable expansion of stages 3 and 4 and of REM sleep. In addition, NCPAP suppressed the presence of cyclic alternating pattern (CAP) in REM sleep and induced an impressive rebound of arousals and of certain CAP variables-i.e., CAP rate, CAP time, number of CAP cycles-which dropped well below the physiologic values expressed by controls. A normal duration of phases A and B was re-established starting the first treatment night. When we matched sleep variables with the indices of daytime function, a significant correlation emerged only between the variations of CAP rate and VAS scores. In particular, improvement of daytime sleepiness was less evident when the ventilatory-induced drop of CAP rate was more pronounced.. The application of CAP variables to the microstructural analysis of sleep may expand our knowledge regarding sleep and respiration.

Topics: Adult; Electroencephalography; Electromyography; Female; Heart Rate; Humans; Male; Middle Aged; Nose; Polysomnography; Positive-Pressure Respiration; Reaction Time; Sleep; Sleep Apnea, Obstructive; Sleep Stages; Sleep, REM

The objective of the study was to determine whether a naso-oesophageal probe modifies sleep and cardiorespiratory patterns in infants with repeated obstructive apnoeas. Two polygraphic recording sessions were conducted in random order for 2 nights on 35 infants suspected to have repeated obstructive sleep apnoeas. One sleep study was performed with a pH probe inserted through the nasal passage down to the distal portion of the oesophagus. The other session was conducted without any naso-oesophageal probe (the baseline study). For the 25 infants who presented repeated obstructive apnoeas during baseline studies, the presence of the probe was associated with a small, but significant, decrease in the number of central apnoeas (median frequency of 18.5 apnoeas per hour without a probe; 16.1 per hour with the probe; P=0.040), and obstructive apnoeas (median of 1.9 apnoeas per hour without a probe; 0.6 per hour with the probe; P=0.016). The presence of the probe was also associated with a small increase in percentage non-rapid eye movement (NREM) sleep frequency. The changes were statistically significant only for infants who had no obstructive apnoea during baseline studies (29 vs. 31%). The presence of a naso-oesophageal probe significantly modifies the infants' respiratory characteristics during sleep. These findings should be considered when reporting and interpreting sleep studies in infants.

Topics: Airway Obstruction; Electrocardiography; Electroencephalography; Electrooculography; Female; Gastroesophageal Reflux; Humans; Infant; Infant, Newborn; Male; Nose; Periodicity; Polysomnography; Random Allocation; Retrospective Studies; Sleep Apnea, Obstructive; Sleep, REM

Autoadjusting nasal continuous positive airway pressure (CPAP) greatly reduces the apnoea/hypopnoea index (AHI), and affords a significant reduction in median pressure (P50) compared-with manually titrated conventional nasal CPAP. The aim of the present study was to test whether these benefits were maintained in the medium term at home, in a double-blind crossover study. Ten sequential subjects (mean AHI 52.9 x h(-1)) were enrolled. After a manual titration, subjects were randomly allocated to 2 months autoadjusting nasal CPAP (AutoSet), followed by 2 months with the AutoSet device in fixed pressure mode at the manually titrated pressure, or vice versa. The machine-scored AHI, P50, and median leak were recorded on 12 nights in each arm, and averaged. Mean+/-SEM AHI was 4.0+/-0.3 x h(-1) in auto mode, and 3.7+/-0.3 x h(-1) in manual mode (NS). Mean+/-SEM P50 was 7.2+/-0.4 cmH2O auto, 9.4+/-0.6 cmH2O manual, average reduction 23+/-4% (p<0.0001). Auto "recommended" pressure was (mean+/-SEM) 10.1+/-0.5 cmH2O (p=0.04 with respect to manual) and peak pressure typically 1 cmH2O higher. Median (+/-SEM) leak was 0.181+/-0.006 L x s(-1) auto (and uncorrelated with AHI or pressure), 0.20+/-0.006 L x s(-1) manual (p=0.003). Compliance was 6.3+/-0.4 h in auto mode and 6.1+/-0.5 h in fixed mode (NS). Apnoea/hypopnoea index during 2 months of home autoadjusting nasal continuous positive airway pressure is comparable to that during conventionally titrated fixed pressure continuous positive airway pressure, while affording a 23% reduction in median pressure but no increase in compliance. Leak did not importantly affect autoadjustment.

Topics: Adult; Aged; Cross-Over Studies; Double-Blind Method; Home Nursing; Humans; Hypoxia; Lung Compliance; Male; Masks; Middle Aged; Nose; Polysomnography; Positive-Pressure Respiration; Sleep Apnea, Obstructive

Increased nasal resistance (NR) can augment upper airway collapse in patients with obstructive sleep apnea (OSA). Posture change can lead to altered nasal resistance. Our study aimed to investigate the influence of posture changes on NR in patients with OSA.. Healthy controls without subjective nasal obstruction (apnea-hypopnea index (AHI) < 5 events/h), patients with OSA and subjective nasal obstruction, and patients with OSA and no subjective nasal obstruction were recruited. NR was measured by active anterior rhinomanometry in sitting, supine, left-lateral, and right-lateral postural positions. Total NR and postural change-related NR increments were calculated and compared among groups.. In total, 26 healthy controls and 72 patients with OSA (mean AHI 39.7 ± 24.8 events/h) were recruited. Of patients with OSA, 38/72 (53%) had subjective nasal obstruction. Compared with controls, patients with OSA and no subjective nasal obstruction had lower total NR (inspiration, p = 0.037; expiration, p = 0.020) in the supine postural position. There was no difference in sitting, left-lateral, and right-lateral total NR among groups. Total NR was higher in lateral compared to sitting posture in both patients with OSA and in controls. The NR increment for sitting to supine postural change was significantly lower in patients with OSA (inspiration, p = 0.003; expiration, p = 0.005) compared with controls. The change in NR showed no statistically significant difference among groups in supine-left or supine-right postural change.. Patients with OSA had lower supine total NR and lower total NR increment in the sitting to supine postural change, which may be related to a different posture-related NR regulatory mechanism. This study provides a new exploratory direction for the compensatory mechanism of the upper airway to collapse during sleep.

Topics: Humans; Nasal Obstruction; Nose; Posture; Sleep; Sleep Apnea, Obstructive

To examine potential clinical, demographic, anthropometric, and polysomnographic predictors of successful auto-adjusting continuous positive airway pressure (CPAP) titration for treatment of obstructive sleep apnea (OSA).. A total of 1222 adults consisting of 874 subjects with optimal CPAP titration (71.5%) and 348 subjects with suboptimal CPAP titration (28.5%) were evaluated. Multivariate analysis resulted in a model with an adequate calibration (Hosmer-Lemeshow chi-square-test: 7.088; p = 0.527), with male sex, higher values of baseline AHI, therapeutic pressure (95th percentile), and mask leak (95th percentile) emerging as significant and independent predictors for suboptimal CPAP titration: adjusted odds ratio (OR): 1.456 (95% confidence interval [CI] 1.076-1.971; p = 0.015), OR: 1.009 (95% CI 1.002-1.016; p = 0.013), OR: 1.281 (95% CI 1.206-1.361; p < 0.001), and 1.035 (1.026-1.043; p < 0.001), respectively.. In a large cohort of adults undergoing auto-adjusting CPAP titration due to moderate-to-severe OSA, male sex, increased values of baseline AHI, pressure requirements, and mask leak were significant predictors for less than optimal CPAP titration.

Topics: Adult; Continuous Positive Airway Pressure; Cross-Sectional Studies; Humans; Male; Nose; Polysomnography; Sleep Apnea, Obstructive

Obesity is a reversible risk factor for obstructive sleep apnoea (OSA). Weight loss can potentially improve OSA by reducing fat around and within tissues surrounding the upper airway, but imaging studies are limited. Our aim was to study the effects of large amounts of weight loss on the upper airway and volume and fat content of multiple surrounding soft tissues.. Participants undergoing bariatric surgery were recruited. Magnetic resonance imaging (MRI) was performed at baseline and six-months after surgery. Volumetric analysis of the airway space, tongue, pharyngeal lateral walls, and soft palate were performed as well as calculation of intra-tissue fat content from Dixon imaging sequences.. Among 18 participants (89% women), the group experienced 27.4 ± 4.7% reduction in body weight. Velopharyngeal airway volume increased (large effect; Cohen's d [95% CI], 0.8 [0.1, 1.4]) and tongue (large effect; Cohen's d [95% CI], - 1.4 [- 2.1, - 0.7]) and pharyngeal lateral wall (Cohen's d [95% CI], - 0.7 [- 1.2, - 0.1]) volumes decreased. Intra-tissue fat decreased following weight loss in the tongue, tongue base, lateral walls, and soft palate. There was a greater effect of weight loss on intra-tissue fat than parapharyngeal fat pad volume (medium effect; Cohen's d [95% CI], - 0.5 [- 1.2, 0.1], p = 0.083).. The study showed an increase in velopharyngeal volume, reduction in tongue volume, and reduced intra-tissue fat in multiple upper airway soft tissues following weight loss in OSA. Further studies are needed to assess the effect of these anatomical changes on upper airway function and its relationship to OSA improvement.

Topics: Female; Humans; Male; Nose; Palate, Soft; Pharynx; Sleep Apnea, Obstructive; Weight Loss

The aim was to evaluate nasal polyposis as a risk factor for nonadherence to continuous positive airway pressure (CPAP) treatment in patients with obstructive sleep apnea (OSA).. This was a population-based, longitudinal analysis of patients starting CPAP treatment for OSA in the Swedish quality registry Swedevox between 2010 and 2018. Data were cross-linked with national registries. The impact of nasal polyposis on CPAP adherence was analyzed using uni- and multivariable logistic and linear regression models. Relevant confounders (age, sex, usage of nasal and oral steroids) were identified using a direct acyclic graph.. Of 20,521 patients with OSA on CPAP treatment (29.5% females), 331 (1.6%) had a diagnosis of nasal polyposis at baseline. At the 1-year follow-up, nasal polyposis was associated with an increased risk of CPAP usage < 4 hours/night (unadjusted odds ratio [OR] 1.21; 95% confidence interval [CI] 0.95-1.55); adjusted OR 1.38; 95% CI 1.08-1.77). In this group, unadjusted nocturnal mean CPAP usage was 15.4 minutes (95% CI -31.62 to 0.83) shorter and was an adjusted 24.1 minutes (95% CI -40.6 to -7.7) shorter compared with patients with OSA without nasal polyposis.. Nasal polyposis is associated with reduced CPAP usage per night. These results highlight the importance of diagnosing nasal polyposis in patients with OSA before the start of CPAP treatment. Treatment of the condition may improve adherence, efficacy, and patient outcomes.. Bengtsson C, Grote L, Ljunggren M, Ekström M, Palm A. Nasal polyposis is a risk factor for nonadherence to CPAP treatment in sleep apnea: the population-based DISCOVERY study.

Topics: Continuous Positive Airway Pressure; Female; Humans; Male; Nose; Patient Compliance; Registries; Risk Factors; Sleep Apnea, Obstructive

Increased nasal resistance as measured by 4-phase rhinomanometry is associated with a paucity of apneas relative to hypopneas in obstructive sleep apnea (OSA) patients. The ratio of hypopneas to apneas for a given apnea hypopnea index (AHI) may influence treatment choice. This study aimed to investigate if OSA patients with an elevated hypopnea apnea ratio are associated with differences in acoustic rhinometry measurements.. One hundred and thirty-nine (n = 139) OSA patients (AHI >5) were enrolled in this prospective case-control study (all male). OSA Diagnosis was established through a type three sleep study. Both acoustic rhinometry and 4-phase rhinomanometry were performed on all patients at baseline and after decongestion. Possible associations between apnea-hypopnea index, oxygen desaturation index, nadir oxygen saturation, apnea index, hypopnea index, hypopnea to apnea ratio and body mass index and were analysed using multiple logistic and linear regression models.. The acoustic rhinometry measurements minimal cross-sectional area, total volume and minimal cross-sectional areas are significantly smaller in patients with increased nasal resistance as measured by 4-phase rhinomanometry (P < 0.01). No consistent statistically significant associations were found between the acoustic rhinometry variables, and the respiratory variables analysed in the sleep studies. OSA patients with an elevated hypopnea apnea ratio are more than 4 times more likely to present with increased nasal resistance measured by 4-phase rhinomanometry (OR = 4.4, 95% CI [1.5-13.2], P < 0.01).. Acoustic rhinometry is significantly associated with 4-phase rhinomanometry. However, acoustic rhinometry measurements are not associated with the respiratory indices routinely measured in OSA in a clinical setting. 4-phase rhinomanometry is a more suitable method for detecting clinically relevant nasal obstruction in obstructive sleep apnea patients.

Topics: Airway Resistance; Case-Control Studies; Humans; Male; Nose; Rhinometry, Acoustic; Sleep Apnea, Obstructive

The aim of this study was to investigate the influence of obstructive sleep apnea and continuous positive airway pressure on the nasal microbiome.. Endonasal swabs from the olfactory groove of 22 patients with moderate and severe obstructive sleep apnea (OSA) and a control group of 17 healthy controls were obtained at the Department of Otorhinolaryngology of the Friedrich-Alexander-Universität Erlangen-Nürnberg. 16S rRNA gene sequencing was performed to further evaluate the endonasal microbiome. In a second step, the longitudinal influence of continuous positive airway pressure (CPAP) therapy on the nasal microbiome was investigated (3-6 and 6-9 months).. Analysis of the bacterial load and β-diversity showed no significant differences between the groups, although patients with severe OSA showed increased α-diversity compared to the control group, while those with moderate OSA showed decreased α-diversity. The evaluation of longitudinal changes in the nasal microbiota during CPAP treatment showed no significant difference in α- or β-diversity. However, the number of bacteria for which a significant difference between moderate and severe OSA was found in the linear discriminant analysis decreased during CPAP treatment.. Long-term CPAP treatment showed an alignment of the composition of the nasal microbiome in patients with moderate and severe OSA as well as an alignment of biodiversity with that of the healthy control group. This change in the composition of the microbiome could be both part of the therapeutic effect in CPAP therapy and a promoting factor of the adverse side effects of the therapy. Further studies are needed to investigate whether the endonasal microbiome is related to CPAP compliance and whether CPAP compliance can be positively influenced in the future by therapeutic modification of the microbiome.

Topics: Continuous Positive Airway Pressure; Humans; Microbiota; Nose; Patient Compliance; RNA, Ribosomal, 16S; Sleep Apnea, Obstructive

Sleep-disordered breathing (SDB) is a common disorder in children, characterized by snoring and/or increased breathing force due to narrowing and increased upper airway collapse while sleeping. Over the last decade, it has been recognized that SDB occurs more frequently in children with craniofacial anomalies, but data in Thailand is quite limited. This study retrospective descriptive study aims to find the prevalence of SDB among children with craniofacial anomalies in Thailand and associated risk factors by collecting data among Thai children with congenital craniofacial anomalies younger than 15 years old who visited the Princess Sirindhorn Craniofacial Center at King Chulalongkorn Memorial Hospital between 2016 and 2021. All children were defined into syndromic and nonsyndromic groups. Data collected from the electronic medical record includes baseline characteristics, diagnosis of craniofacial anomalies, associated risk factors, diagnosis of SDB, diagnostic tools, and treatment. Total of 512 children, there were 80 children (15.4%) who had SDB. The most diagnosis was 51 (10%) obstructive sleep apnea followed by 27 (5.3%) primary snoring and 2 (0.4%) obstructive hypoventilation. The prevalence of SDB in the syndromic group was 43 (46.7%) while the nonsyndromic group was 37 (8.6%), ( P <0.001). The risk factors associated with SDB were overweight, allergic rhinitis, tonsillar hypertrophy, high arch palate, micrognathia, and syndromic craniofacial anomalies. The prevalence of SDB is higher in children with syndromic craniofacial anomalies than in the nonsyndromic group. Knowledge of the prevalence and related factors can lead to better care, including early screening and monitoring of SDB in craniofacial patients.

Topics: Adolescent; Child; Humans; Nose; Retrospective Studies; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Snoring

Obstructive sleep apnea (OSA) and nasal obstruction are common in the general population and frequently treated by otolaryngologists and facial plastic surgeons. Understanding the appropriate pre-, peri-, and postoperative management of OSA patients undergoing functional nasal surgery is important. OSA patients should be appropriately counseled in the preoperative period on their increased anesthetic risk. In OSA patients who are continuous positive airway pressure (CPAP) intolerant, the role of drug-induced sleep endoscopy should be discussed with the patient, and depending on the surgeon's practice may prompt referral to a sleep specialist. Should multilevel airway surgery be indicated, it can safely be performed in most OSA patients. Surgeons should communicate with the anesthesiologist regarding an airway plan given this patient population's higher propensity for having a difficult airway. Given their increased risk of postoperative respiratory depression, extended recovery time should be given to these patients and the use of opioids as well as sedatives should be minimized. During surgery, one can consider using local nerve blocks to reduce postoperative pain and analgesic use. After surgery, clinicians can consider opioid alternatives such as nonsteroidal anti-inflammatory agents. Neuropathic agents, such as gabapentin, require further research in their indications for managing postoperative pain. CPAP is typically held for a period of time after functional rhinoplasty. The decision on when to restart CPAP should be individualized to the patient based on their comorbidities, OSA severity, and surgical maneuvers performed. More research would provide further guidance in this patient population to shape more specific recommendations regarding their perioperative and intraoperative course.

Topics: Humans; Nasal Obstruction; Nose; Pain, Postoperative; Rhinoplasty; Sleep Apnea, Obstructive

Patients with obstructive sleep apnoea (OSA) frequently present with some form of upper airway anatomical impairment. Considerable research has been conducted on the role of the structures of the jaw and pharynx in the pathogenesis of OSA; however, the significance of the nose is somewhat unclear. Computed tomography is a widely used imaging modality for assessing the nasal cavity and paranasal sinuses, but only a small amount of the acquired data is used. Our aim was to ascertain whether the size of the cross-sectional areas of the nasal airway, measured from cone beam computed tomography (CBCT) images, is associated with OSA severity.. A total of 58 patients with OSA, without any major paranasal sinus inflammatory pathology, were included in this register-based study. Patients had previously undergone ambulatory polysomnography and CBCT. The cross-sectional areas of the nasal cavity were measured in CBCT coronal sections. Statistical analyses were performed to determine any correlation between the cross-sectional area measurements and apnoea-hypopnoea index (AHI) or any significant difference in cross-sectional areas between AHI severity groups.. No correlation was found between AHI and the smallest, total, or sum of the anterior cross-sectional areas of the nasal airway. Furthermore, there was no statistically significant difference in the cross-sectional areas between patients with the highest and lowest AHI.. The small cross-sectional area of the anterior nasal cavity in patients without any major nasal pathology does not appear to be associated with OSA severity.

Topics: Cone-Beam Computed Tomography; Humans; Nose; Pharynx; Sleep Apnea, Obstructive; Tomography, X-Ray Computed

Topics: Aged; Continuous Positive Airway Pressure; Female; Humans; Male; Middle Aged; Nose; Respiration; Sleep; Sleep Apnea, Obstructive

Alternatives to positive airway pressure therapy, including surgery, represent an important area of research. Specifically, predictors of response to surgical therapy remain underdeveloped. Drug-induced sleep endoscopy (DISE) holds promise as a diagnostic tool to identify patient-specific causes of airway collapse. Herein, we present a novel, standardized approach which combines anatomic and physiologic measurements during DISE. Our DISE platform measures airflow, airway compliance, airway collapsibility, and structural drivers of collapse. Taken together, these inputs provide a comprehensive framework to further inform the surgeon in providing personalized care of the patient with obstructive sleep apnea.

Topics: Endoscopy; Humans; Nose; Polysomnography; Sleep; Sleep Apnea, Obstructive

The aim of our study was to investigate the presence of dysphagia in patients with Obstructive Sleep Apnoea (OSA) and to correlate swallowing impairment with hypnologic and anatomic parameters.. The study population includes 36 patients suffering from OSA. Patients were divided into two groups using the presence of dysphagia as a distinctive parameter. Group 1 included 27 OSA patients without signs of dysphagia and Group 2 included 9 OSA patients with signs of dysphagia.. The age of patients in Group 2 was higher compared with the age of patients in Group 1. Analysis of Continuous Positive Airway Pressure (CPAP), obtained in the titration phase, showed that OSA patients with signs of dysphagia required a higher level of CPAP pressure than those who were not affected by swallowing abnormalities (12.6 ± 1. In clinical practice, all OSA patients should undergo a complete ENT exam, including assessment of swallowing, before CPAP therapy is started. This may predict the need for higher CPAP pressure settings to resolve apnoea episodes in the presence of dysphagia as well as guide the choice of CPAP interfaces (orofacial vs. nasal) in these patients.. Disfagia e OSA.. Il nostro studio ha avuto come obiettivo la ricerca nei pazienti OSA di evidenze di disfagia e l’associazione della presenza di disfagia alla anatomia delle prime vie aero-digestive e ai parametri ipnologici ed emogasanalitici di questi pazienti.. Tutti i pazienti sono stati sottoposti a emogasanalisi, spirometria, rinomanometria, videofibrorinolaringoscopia, valutazione fibroendoscopica della deglutizione (FEES), polisonnografia notturna, studio di titolazione della pressione di lavoro di CPAP, somministrazione del questionario “SWAL-QOL”.. Il 25% della popolazione studiata ha presentato segni subclinici di disfagia. Il gruppo dei pazienti non disfagici era formato da soggetti più giovani rispetto al gruppo dei pazienti disfagici. Il distretto orofaringeo è risultato essere il sito di ostruzione più frequente per entrambi i gruppi. Nello studio di titolazione della pressione di lavoro di CPAP, i pazienti disfagici necessitano di valori di pressione più alti.. Un paziente OSA su 4 ha presentato segni di disfagia. La disfagia è associata a valori più elevati di pressione allo studio di titolazione della CPAP. I pazienti OSA hanno un rischio più elevato di presentare disturbi di deglutizione con l’avanzare dell’età rispetto alla popolazione generale.

Topics: Continuous Positive Airway Pressure; Deglutition; Deglutition Disorders; Humans; Nose; Sleep Apnea, Obstructive

Revealing the structural morphology and inner flow field of the upper airway is important for understanding obstructive sleep apnea-hypopnea syndrome (OSAHS) incidence phenomena and pathological diagnosis in children. However, prior work on this topic has been focused on adults and the findings cannot be directly extrapolated to children because of different inducing factors. Therefore, this paper employs a simulation method to investigate upper airway flow characteristics of childhood OSAHS. It is found that the Reynold number changes highly throughout the whole upper airway, and the laminar assumption is no longer suitable for low Reynold number flow, which is much unlike classic fluid mechanics. Turbulent models of Standard k-ω and Spalart-Allmaras were developed prior to suggestion. The simulation is validated by experiments with an error of approximately 20%. Additionally, carried out in this analysis is the influence of adenoidal hypertrophy with different narrow levels. The cross-sectional area, flow velocity, pressure drop and volume rate will change greatly when the narrow level is above 64% of the upper airway, which can be a quantitative explanation for medical intervention if adenoid hypertrophy blocks 2/3 of the upper airway in the common clinical judgment of otorhinolaryngology. It is expected that this paper can be a meaningful instruction on OSAHS surgery plan making as well as recovery evaluation postoperatively.

Topics: Adenoids; Adult; Child; Computer Simulation; Humans; Hypertrophy; Nose; Sleep Apnea, Obstructive; Syndrome

Drug-induced sleep endoscopy with positive airway pressure (DISE-PAP) is a new technique that allows for both the visualization of upper airway collapse as well as to evaluate the degree of airway collapsibility. This DISE-PAP protocol provides an affordable and clinically efficient manner in which to immediately implement this technique in clinical practice. Laryngoscope, 132:2076-2077, 2022.

Topics: Endoscopy; Humans; Nose; Sleep; Sleep Apnea, Obstructive

The aim of this study was to evaluate the impact of nasomaxillary expansion using skeletally anchored transpalatal distraction (TPD) in children without transverse maxillary deficiency that were previously treated by rapid palatal expansion (RPE).. Twenty-nine consecutive children were treated by TPD. Twenty-five children, aged 10-16 years completed pre- and post-operative clinical evaluations, questionnaires (OSA-18), cone beam computed tomography (CBCT), and polysomnography (PSG). The pre- and post-operative CBCT data were used to reconstruct the 3-dimensional shape of the upper airway. Two measures of airflow function (pressure and velocity) were simulated by using computational fluid dynamics (CFD) at four different airway segments (nasal, nasopharyngeal, oropharyngeal and hypopharyngeal).. Twenty-three patients (92%) experienced improvement based on PSG. The apnea hypopnea index (AHI) improved from 6.72 ± 4.34 to 3.59 ± 5.11 (p<0.001) events per hour. Clinical symptoms based on OSA-18 scores were improved in all patients. Twenty-five patients (100%) had successful expansion defined as separation of the midpalatal suture at least 1mm from anterior nasal spine (ANS) to posterior nasal spine (PNS). The nasal sidewall widening was 2.59 ± 1,54 mm at canine, 2.91 ± 1,23 mm at first molar and 2.30 ± 1,29 mm at PNS. The ratio of dental expansion to nasal expansion was 1.12:1 (2.90mm:2.59mm) at canine and 1.37:1 (3.98mm:2.91mm) at first molar. The nasal airflow pressure reduced by 76% (-275.73 to -67.28 Pa) and the nasal airflow velocity reduced by over 50% (18.60 to 8.56 m/s).. Nasomaxillary expansion by skeletally anchored TPD improves OSA in children without transverse maxillary deficiency that were previously treated by RPE. A nearly parallel anterior-posterior opening of the mid-palatal suture achieves enlargement of the entire nasal passage with improvement of the airflow characteristics in the nasal and pharyngeal airway. The improved airflow characteristic is significantly correlated with the improved polysomnographic findings, thus demonstrating that nasomaxillary expansion in previously expanded patients is a viable treatment option.. L’objectif de cette étude était d’évaluer l’impact de l’expansion nasomaxillaire à l’aide d’une distraction transpalatine (DTP) à ancrage squelettique chez des enfants sans insuffisance maxillaire transversale et qui ont été précédemment traités par expansion palatine rapide (EPR).. Vingt-neuf enfants enrôlés consécutivement ont été traités par DTP. Vingt-cinq enfants, âgés de 10 à 16 ans, ont été soumis à des évaluations cliniques pré- et postopératoires, des questionnaires (OSA-18), une tomographie à faisceau conique (CBCT) et une polysomnographie (PSG). Les données CBCT pré- et postopératoires ont été utilisées pour reconstruire la forme tridimensionnelle des voies aériennes supérieures. Deux mesures des caractéristiques d’écoulement de l’air (pression et vitesse) ont été simulées en utilisant la dynamique des fluides computationnelle (DFC) dans quatre segments différents des voies aériennes (nasal, nasopharyngé, oropharyngé et hypopharyngé).. Vingt-trois patients (92 %) ont bénéficié d’une rapide amélioration objectivée par la PSG. L’indice d’apnée-hypopnée (IAH) est passé de 6,72 ± 4,34 à 3,59 ± 5,11 (p<0,001) événements par heure. Les symptômes cliniques évalués avec les scores du questionnaire OSA-18 se sont améliorés chez tous les patients. Pour les vingt-cinq patients (100 %), l’expansion a été réussie, selon le critère d’une séparation de la suture médiopalatine d’au moins 1 mm, de l’épine nasale antérieure (ENA) jusqu’à l’épine nasale postérieure (ENP). L’élargissement de la distance entre les parois nasales latérales était de 2,59 ± 1,54 mm au niveau de la canine, de 2,91 ± 1,23 mm au niveau de la première molaire et de 2,30 ± 1,29 mm à l’épine nasale postérieure. Le rapport entre l’expansion dentaire et l’expansion nasale était de 1,12:1 (2,90 mm:2,59 mm) au niveau de la canine et de 1,37:1 (3,98 mm:2,91 mm) au niveau de la première molaire. La pression du flux d’air nasal a diminué de 76 % (-275,73 à -67,28 Pa) et la vitesse du flux d’air nasal a diminué de plus de 50 % (18,60 à 8,56 m/s).. L’expansion nasomaxillaire à l’aide d’une distraction transpalatine à ancrage squelettique améliore le SAOS chez les enfants sans déficit maxillaire transverse et qui ont été auparavant traités par EPR. Une ouverture antéro-postérieure et presque parallèle de la suture médiopalatine permet d’élargir l’ensemble du passage nasal et d’améliorer les caractéristiques du flux d’air dans les voies aériennes nasales et pharyngées. L’amélioration des caractéristiques de l’écoulement d’air est significativement corrélée à l’amélioration des résultats polysomnographiques, démontrant ainsi que l’expansion nasomaxillaire chez des patients précédemment traités par EPR est une option thérapeutique viable.

Topics: Cone-Beam Computed Tomography; Humans; Nose; Palatal Expansion Technique; Pharynx; Sleep Apnea, Obstructive

To determine the indications, anesthesiological and surgical procedure and interest of drug-induced sleep endoscopy in the treatment of adult obstructive sleep apnea syndrome.. A redactional committee of 17 experts was set up. Conflicts of interest were disclosed and followed up throughout the process of drawing up the guidelines. The work received no funding from any firm dealing in health products (drugs or devices). The GRADE (Grading of Recommendations Assessment, Development and Evaluation) method was applied to assess the quality of the data on which the guidelines were founded. It was stressed that strong recommendations should not be made on the basis of poor-quality or insufficient data.. The committee studied 29 questions on 5 topics: indications and contraindications, anesthetic technique, surgical technique, interpretation and reporting of results, and management guided by results.. Expert review and application of the GRADE method led to 30 guidelines: 10 with high level of evidence (Grade 1+ or 1-), 19 with low level (GRADE 2+ or 2-) and 1 expert opinion.. Experts fully agreed on the strong guidelines formalizing the indications and modalities of drug-induced sleep endoscopy for adult obstructive sleep apnea syndrome.

Topics: Adult; Endoscopy; Humans; Nose; Sleep; Sleep Apnea, Obstructive

The aim of this study was to evaluate the impact of nasomaxillary expansion using skeletally anchored transpalatal distraction (TPD) in children without transverse maxillary deficiency that were previously treated by rapid palatal expansion (RPE).. Twenty-nine consecutive children were treated by TPD. Twenty-five children, aged 10-16 years completed pre- and post-operative clinical evaluations, questionnaires (OSA-18), cone beam computed tomography (CBCT), and polysomnography (PSG). The pre- and post-operative CBCT data were used to reconstruct the 3-dimensional shape of the upper airway. Two measures of airflow function (pressure and velocity) were simulated by using computational fluid dynamics (CFD) at four different airway segments (nasal, nasopharyngeal, oropharyngeal and hypopharyngeal).. Twenty-three patients (92%) experienced improvement based on PSG. The apnea hypopnea index (AHI) improved from 6.72±4.34 to 3.59±5.11 (p<0.001) events per hour. Clinical symptoms based on OSA-18 scores were improved in all patients. Twenty-five patients (100%) had successful expansion defined as separation of the midpalatal suture at least 1 mm from anterior nasal spine (ANS) to posterior nasal spine (PNS). The nasal sidewall widening was 2.59±1.54 mm at canine, 2.91±1.23 mm at first molar and 2.30±1.29 mm at PNS. The ratio of dental expansion to nasal expansion was 1.12:1 (2.90 mm:2.59 mm) at canine and 1.37:1 (3.98 mm:2.91 mm) at first molar. The nasal airflow pressure reduced by 76% (-275.73 to -67.28 Pa) and the nasal airflow velocity reduced by over 50% (18.60 to 8.56 m/s).. Nasomaxillary expansion by skeletally anchored TPD improves OSA in children without transverse maxillary deficiency that were previously treated by RPE. A nearly parallel anterior-posterior opening of the mid-palatal suture achieves enlargement of the entire nasal passage with improvement of the airflow characteristics in the nasal and pharyngeal airway. The improved airflow characteristic is significantly correlated with the improved polysomnographic findings, thus demonstrating that nasomaxillary expansion in previously expanded patients is a viable treatment option.

Topics: Cone-Beam Computed Tomography; Humans; Maxilla; Nasal Cavity; Nose; Palatal Expansion Technique; Palate; Sleep Apnea, Obstructive

Surgical maxillary expansion for the treatment of obstructive sleep apnea (OSA) has become common place. To maximize airway improvement, over-expansion of the maxilla can occur, resulting in an excessively widened maxilla that creates a mismatch to the mandible. Therefore, mandibular symphyseal distraction osteogenesis (MSDO) to widen the mandible along with maxillary expansion is being increasingly advocated in OSA surgery.. The authors discuss their 20-year experience with MSDO and surgical maxillary expansion. They also analyze the airway impact between Distraction Osteogenesis Maxillary Expansion (DOME) and Endoscopically-Assisted Surgical Expansion (EASE) based on currently available computational fluid dynamic (CFD) data, which has implications in whether MSDO needs to be considered.. The goal of surgical maxillary expansion is to enlarge the nasal cavity and reduce the airway resistance. CFD data demonstrates that EASE results in a much greater reduction in airway resistance as compared to DOME. EASE achieved a 12-fold reduction in nasal airway resistance compared to 3-fold reduction by DOME; a 12-fold reduction of retropalatal airway resistance as compared to 3-fold reduction by DOME; a 10-fold reduction of oropharyngeal airway resistance as compared to a 3-fold reduction by DOME, and an 8-fold reduction of hypopharygeal airway resistance as compared to a 3-fold reduction by DOME. Because there is no physiologic basis or data that demonstrates mandibular widening improves OSA, an airway centric surgical expansion technique such as EASE can achieve a much greater airway impact without needing excessive maxillary widening, thus eliminating the necessity MSDO.

Topics: Humans; Mandible; Nose; Osteogenesis, Distraction; Palatal Expansion Technique; Sleep Apnea, Obstructive

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.. 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.. 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).. 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.

Topics: Humans; Nasal Obstruction; Nasal Surgical Procedures; Nose; Sleep Apnea, Obstructive

The aim of this study was to evaluate the relationship between three-dimensional craniofacial and upper airway anatomical variables and severity of obstructive sleep apnoea (OSA) using cone beam computed tomography (CBCT).. This was a prospective observational study, consisted of 95 adult OSA whose polysomnography and CBCT were available. Three-dimensional craniofacial and upper airway anatomical analysis were performed using 12 CBCT variables, including sagittal and vertical jaw relationships, maxillary width, the volume, length and minimum axial area of upper airway. The severity of OSA was evaluated through the apnea-hypopnea index (AHI). A hierarchical regression was performed to analyze the relationship between OSA severity and craniofacial and upper airway anatomical variables after controlling patients' demographic characteristics (gender, age, and BMI).. After controlling patients' gender, age, and BMI, individual CBCT variables including MAA, V-RPA, L-RPA and Go-Me were related to AHI. The final hierarchical regression model with demographic variables in Step 1 and CBCT variables (MAA, L-RPA and Go-Me) in Step 2 indicated that CBCT variables added additional explanatory power for AHI (ΔF(3,88) = 5.176, P = 0.002). Among these variables, L-RPA and Go-Me were statistically significant (P < 0.05).. The OSA severity was expressed by AHI alone.. Three-dimensional craniofacial and upper airway morphology played an essential role in OSA severity. The most relevant anatomical characteristic with OSA severity were the length of retropalatal airway and mandibular body, which could be used to recognize severe OSA patients and as estimators for selecting the most appropriate treatment modality for OSA patients.

Topics: Adult; Cone-Beam Computed Tomography; Humans; Mandible; Nose; Polysomnography; Sleep Apnea, Obstructive

Respiratory disorder is a disease with a very high incidence, in which obstructive apnea-hypopnea syndrome is the most harmful. It has become a common and frequently occurring disease, which seriously influences the health of the affected population. The pathogenesis of obstructive sleep apnea/hypopnea syndrome (OSAHS) is numerous. With the continuous research on OSAHS disease, it has been found that one of its main pathogeneses is caused by the anatomical characteristics of upper airway obstruction induced during sleep. The narrowing and collapse of any plane can affect the ventilation of the upper respiratory tract. In recent years, with the deepening of research, the importance of the upper respiratory tract obstruction as a source of the disease has attracted increasing attention. Nasal stenosis can cause increased nasal resistance, increased pharyngeal inhalation negative pressure, soft palate collapse, and narrow pharyngeal cavity, resulting in open mouth breathing, which can be the initiating factor of the upper airway obstruction. With the development and popularization of nasal endoscopy technology, domestic and foreign scholars have reported more on the treatment of rhinogenic OSAHS with nasal cavity expansion, but they are different. There is still more controversy; the main controversy centered on the effective rate of surgical treatment and the improvement of objective indicators. Therefore, this study performed individualized nasal cavity expansion for patients with OSAHS who are mainly rhinogenic, from subjective symptoms, objective indicators, and effective rate of surgery.. There are uploaded sleep monitoring, nasal reflex, nasal resistance, and nasal symptoms before and after surgery.. Spirometer examination records, along with apnea-hypopnea index and minimum arterial blood oxygen saturation, the minimum cross-sectional area of the nasal cavity, nasal cavity volume, nasal airway resistance, total nasal respiratory volume, and other information. Also we fill in the nasal obstruction symptom assessment scale, sleepiness scale, and study and analyze the surgical effect of nasal cavity expansion.

Topics: Adult; Humans; Nasal Cavity; Nasal Obstruction; Nose; Sleep; Sleep Apnea, Obstructive

Continuous positive airway pressure (CPAP) is the current gold-standard treatment for moderate to severe obstructive sleep apnea (OSA), and upper airway anatomy plays an increasingly important role in evaluating the efficacy of CPAP therapy. The aim of this observational study was to investigate the influence of upper airway anatomy on CPAP titration in OSA patients assessed by computed tomography (CT) during Müller's maneuver.. Consecutive patients under investigation for OSA by undergoing polysomnography and CT scan of the upper airway while awake were enrolled. Successful full-night manual titration was performed to determine the optimal CPAP pressure level for OSA patients in supine position using a nasal mask.. A total of 157 subjects (134 males and 23 females) were included. Both apnea-hypopnea index (AHI) and LaSO2 significantly correlated with CPAP titration level, upper airway length (UAL), distance from mandibular plane to hyoid bone (MPH), and neck circumference (all p < 0.05). There were significant positive correlations between CPAP titration level and UAL (r = 0.348, p = 0.000) and MPH (r = 0.313, p = 0.002). Stepwise multiple linear regression analyses were performed to evaluate the independent predictors of AHI, LaSO2, and CPAP titration level. CPAP titration level was identified as an independent explanatory variable for AHI and LaSO2 after adjustment for confounders. Multiple linear regression analyses also indicated that body mass index (BMI) and UAL were independently associated with CPAP titration level (all p < 0.05).. Upper airway abnormalities combined with anthropometric parameters play important roles in CPAP titration for OSA patients, providing additional insight into the factors influencing OSA treatment strategies. UAL and BMI should be taken into consideration when choosing CPAP titration level to improve CPAP compliance.

Topics: Adult; Aged; Body Mass Index; Continuous Positive Airway Pressure; Female; Humans; Larynx; Male; Middle Aged; Nose; Pharynx; Sleep Apnea, Obstructive; Tomography, X-Ray Computed; Young Adult

Nasal masks are usually the first choice for CPAP therapy, but patients may experience side effects. There are limited data regarding the efficacy of nasal pillows masks during CPAP titration. This study aimed to compare the polysomnography outcomes during CPAP titration while comparing two types of masks (nasal and pillows) and to assess whether or not the patient characteristics differed between mask preferences.. In a sleep-disorders clinic, we prospectively analyzed all patients undergoing CPAP titration for three consecutive months. CPAP pressures were manually titrated. Anthropometric data (age, sex, body mass index, and neck and waist circumferences) and OSA severity were documented. Patients completed a self-administered questionnaire that measured nasal obstruction (NOSE scale). Before titration, both types of masks were presented to patients, and each of them chose the one they preferred.. Nasal pillows masks seem to be as effective as nasal masks and may be considered to be an initial choice for CPAP titration.

Topics: Adult; Aged; Aged, 80 and over; Continuous Positive Airway Pressure; Female; Humans; Male; Masks; Middle Aged; Nose; Prospective Studies; Sleep Apnea, Obstructive; Treatment Outcome; Young Adult

We report a case of a 65-year-old obese female who developed a unilateral nasal cerebrospinal fluid leak after starting autotitrating positive airway pressure therapy for obstructive sleep apnea. The cerebrospinal fluid leak was confirmed by β-2 transferrin testing of the nasal fluid, as well as by identification of the leak through the anterior cribriform plate after administration of intrathecal fluorescein. The cerebrospinal fluid leak was successfully repaired endoscopically, and autotitrating positive airway pressure was reinitiated 1 month postoperatively.. Khan O, Craig JR, Begum J, Skiba V. Images: unilateral rhinorrhea in a patient starting autotitrating positive airway pressure therapy for obstructive sleep apnea.

Topics: Aged; Continuous Positive Airway Pressure; Female; Humans; Nose; Rhinorrhea; Sleep Apnea, Obstructive

阻塞性睡眠呼吸暂停低通气综合征（OSAHS）是一种临床常见的睡眠呼吸障碍性疾病，发病率正在逐年上升。上气道扩张肌结构和功能异常是OSAHS的重要致病机制之一。大量研究发现，OSAHS引起的慢性间歇性缺氧（CIH）、高碳酸血症、睡眠片段化可通过各种机制影响上气道扩张肌的结构和功能，形成恶性循环加重病情。因此，本文现就OSAHS与上气道扩张肌的相互关系及可能的机制综述如下。.

Topics: Humans; Muscles; Nose; Sleep Apnea, Obstructive; Syndrome

Tongue motion patterns (TMP) can influence the outcome of upper airway stimulation (UAS) in the treatment of obstructive sleep apnea (OSA). As a postoperative control, the cuff position of the stimulation lead is monitored via X‑ray imaging. A multidimensional X‑ray assessment system was established and the association between these positional assessments and TMP was investigated 1 year after implantation.. The study on TMP and the X‑ray assessments were carried out at a German ear nose and throat clinic as an implantation center. The TMPs were assessed under bipolar electrode configuration and were categorized according to the currently available literature as right-sided protrusion (RP), left-sided protrusion (LP), bilateral protrusion (BP) and mixed activation (MA). The X‑ray assessment was carried out in five dimensions: the position relative to the mandible and hyoid, cuff steepness in the lateral view of the neck, the cuff position based on the single electrode, and the lead connection to the cuff in the anterior-posterior view. The analyses were performed by three raters with different medical backgrounds and knowledge regarding TMP.. In approximately 60% of patients, the apnea-hypopnea index was reduced to below 15/h 1 year after implantation. The most common TMPs were RP and BP (82.9%). The interrater variability of the X‑ray assessment was good except for one category. Furthermore, no relevant associations were found apart from the correlation between a favorable TMP and the cuff position with respect to the lateral position of the stimulation cable.. Despite good interrater variability and convenient usage of the suggested X‑ray assessment system, this approach did not enable the identification of any associations by which a TM and, therefore, a possible straightforward or complicated treatment pathway could be predicted. Attention should possibly be paid to a rotation of the cuff during implantation with a lateral position of the stimulation lead.

Topics: Electric Stimulation Therapy; Female; Humans; Male; Nose; Polysomnography; Respiratory System; Sleep Apnea, Obstructive; Tongue

This study correlates objective and subjective measurements associated with obstructive sleep apnea (OSA) to define the efficacy of Distraction Osteogenesis Maxillary Expansion (DOME) to treat adult OSA patients with narrow maxilla and nasal floor.. This is a retrospective study reviewing cases from September 2014 through April 2018 with 75 eligible subjects. Inclusion criteria required OSA confirmed by attended polysomnography (PSG). Pre- and Post-operative clinical data were measured at the Stanford Sleep Medicine and Stanford Sleep Surgery Clinics. DOME is a two-step process starting with insertion of custom-fabricated maxillary expanders anchored to the hard palate by mini-implants followed by minimally invasive osteotomies. After maxillary expansion was complete, orthodontic treatment to restore normal occlusion was initiated. Perioperative Apnea-Hypopnea Index (AHI), Epworth Sleepiness Scale (ESS), Nasal Obstruction Symptom Evaluation (NOSE), and Oxygen Desaturation Index (ODI) were measured for 43, 72, 72, and 34 subjects respectively. Statistical analysis was performed using paired T-test with significance set at p-value < 0.05.. The mean age of test subjects was 30.5 ± 8.5 years with a gender distribution of 57 males and 18 females. There was a significant reduction in pre and post-operative NOSE score (10.94 ± 5.51 to 3.28 ± 2.89, p < 0.0001), mean ESS score (10.48 ± 5.4 to 6.69 ± 4.75, p < 0.0001), and AHI (17.65 ± 19.30 to 8.17 ± 8.47, p < 0.0001) with an increased percentage of REM sleep (14.4 ± 8.3% to 22.7 ± 6.6%, p = 0.0014). No significant adverse effects were identified.. DOME treatment reduced the severity of OSA, refractory nasal obstruction, daytime somnolence, and increased the percentage of REM sleep in this selected cohort of adults OSA patients with narrow maxilla and nasal floor.

Topics: Adult; Female; Humans; Male; Maxilla; Nose; Osteogenesis, Distraction; Palatal Expansion Technique; Polysomnography; Retrospective Studies; Sleep Apnea, Obstructive; Sleep, REM

To investigate long-term complications of newer reconstructive palate surgery techniques.. Retrospective case-series analysis.. Retrospective six-country clinical study of OSA patients who had nose and palate surgery.. There were 217 patients, mean age = 43.9 ± 12.5 years, mean body mass index = 25.9 ± 4.7, mean preoperative apnea-hypopnea index [AHI] = 30.5 ± 19.1, follow-up 41.3 months. A total of 217 palatal procedures were performed, including 50 expansion sphincter pharyngoplasties (ESP), 34 functional expansion pharyngoplasties (FEP), 40 barbed reposition pharyngoplasties (BRP), 64 modified uvulopalatopharyngoplasties (mUPPP), 11 uvulopalatal flap procedures (UPF), nine suspension pharyngoplasties (SP), eight relocation pharyngoplasties (RP), and one z-pharyngoplasty (ZPP). Complications included were constant and/or felt twice per week; dry throat (7.8%), throat lump feeling (11.5%), throat phlegm (10.1%), throat scar feeling (3.7%), and difficulty swallowing (0.5%). Of the 17 patients who had a dry throat complaint, two were constant (one SP, one RP), 15 were occasional (10 mUPPP, three SP, two BRP). Of the 25 patients with the throat lump feeling, four were constant (three RP, one ZPP), 21 were occasional (10 mUPPP, five SP, five UPF, one BRP). Of the 22 patients with the throat phlegm feeling, four were constant (two SP, two RP), 18 were occasional (10 mUPPP, four BRP, two FEP, two SP). Of the eight patients with throat scar feeling, eight were occasional (four SP, two mUPPP, one FEP, one RP), none were constant. One patient had difficulty swallowing (RP procedure). There was no velopharyngeal incompetence, taste disturbance, nor voice change. Highest symptom complaints were mUPPP, SP, and RP, whereas the lowest symptom complaint was ESP.. Newer palatal techniques have shown to have less long-term complications compared to the older ablative techniques.. 4 Laryngoscope, 130:2281-2284, 2020.

Topics: Adult; Female; Humans; Male; Middle Aged; Nose; Palate; Pharyngitis; Plastic Surgery Procedures; Postoperative Complications; Retrospective Studies; Severity of Illness Index; Sleep Apnea, Obstructive; Time Factors; Treatment Outcome; Velopharyngeal Insufficiency

Topics: Child; Humans; Hydrodynamics; Nose; Polysomnography; Sleep Apnea, Obstructive

Sleep apnea is a sleep disorder that occurs when the breathing of a person is interrupted during the sleep. This interruption occurs because of the patient has narrowed airways and the upper airways muscles relax, closes in and blocks the airway. Therefore, any forces or reaction originated by the air flow dynamics over the relaxed upper airways muscles could make to close the upper airways, and consequently the air could not flow into your lungs, provoking sleep apnea. Fully describing the dynamic behavior of the airflow in this area is a severe challenge for the physicians. In this paper we explore the dynamic behavior of airflow in the upper airways of 6 patients suffering obstructive sleep apnea with/without a mandibular advancement device using computational fluid dynamics. The development of flow unsteadiness from a laminar state at entry to the pharynx through to the turbulent character in the soft palate area is resolved using an accurate numerical model. Combining the airflow solution with a geometrical analysis of the upper airways reveals the positive effects of mandibular advance device in the air flow behavior (pressure drop). Improved modeling of airflow and positioning of mandibular advance device could be applied to improve diagnosis and treatment of obstructive sleep apnea.

Topics: Adult; Computer Simulation; Female; Humans; Hydrodynamics; Larynx; Male; Mandible; Middle Aged; Nose; Palate, Soft; Pharynx; Polysomnography; Pulmonary Ventilation; Respiration; Sleep Apnea Syndromes; Sleep Apnea, Obstructive

The purpose of this study was to investigate the effect of breathing route on the collapsibility of the pharyngeal airway in patients with obstructive sleep apnea by using computational fluid dynamics technology.. This study examined Japanese men with obstructive sleep apnea. Computed tomography scans of the nose and pharynx were taken during nasal breathing with closed mouth, nasal breathing with open mouth, and oral breathing while they were awake. Three-dimensional reconstructed stereolithography models and digital unstructured grid models were created and airflow simulations were performed using computational fluid dynamics software.. Airflow velocity was significantly higher during oral breathing than during nasal breathing with open or closed mouth. No significant difference in maximum velocity was noted between nasal breathing with closed and open mouth. However, airflow during nasal breathing with open mouth was slow but rapidly sped up at the lower level of the velopharynx, and then spread and became a disturbed, unsteady stream. In contrast, airflow during nasal breathing with closed mouth gradually sped up at the oropharyngeal level without spreading or disturbance. Negative static pressure during oral breathing was significantly decreased; however, there were no significant differences between nasal breathing with closed or open mouth.. Computational fluid dynamics results during nasal and oral breathing revealed that oral breathing is the primary condition leading to pharyngeal airway collapse based on the concept of the Starling Resistor model. Airflow throughout the entirety of the breathing route was smoother during nasal breathing with closed mouth than that with open mouth.

Topics: Adult; Computer Simulation; Humans; Japan; Male; Middle Aged; Mouth; Nose; Pharynx; Pulmonary Ventilation; Respiration; Sleep Apnea, Obstructive

To investigate the changes of blood pressure (BP) on patients with obstructive sleep apnea/hypopnea syndrome (OSA) before and after upper airway surgery.. Case series with chart review.. Tertiary academic medical center.. Patients with OSA who underwent upper airway surgery were enrolled. We retrospectively investigated the nighttime and daytime BP before and at least 3 months after OSA surgery. Paired. In total, 176 patients with OSA (149 men, 27 women; mean age, 42.9 years; mean apnea/hypopnea index, 43.1/h) were enrolled in this study. The overall nighttime and daytime BP decreased significantly before and after OSA surgery (daytime systolic BP was reduced from 137.3 ± 14.0 mm Hg to 132.7 ± 17.0 mm Hg,. Surgical modifications of the upper airways for patients with OSA could benefit blood pressure.

Topics: Adult; Blood Pressure; Female; Humans; Male; Middle Aged; Nose; Oxygen; Palate; Polysomnography; Retrospective Studies; Sleep; Sleep Apnea, Obstructive; Tongue

Mask type (nasal versus oronasal) can affect the optimal pressure required to correct the apnea/hypopnea index (AHI) in obstructive sleep apnea (OSA) subjects treated with CPAP. Our objective was to evaluate if mask type influenced CPAP titration outcomes in OSA patients.. A retrospective study of individuals with a baseline AHI ≥ 15.0/h, who received an auto-adjusting CPAP titrating device (S9 AutoSet ResMed. CPAP mask type based on individual preferences exerts profound effects on optimal CPAP pressures and efficacy. Patients titrated with OM showed higher pressure requirements, had higher a leak, and higher residual AHI when compared to NM, which may adversely impact treatment adherence and other health outcomes.

Topics: Continuous Positive Airway Pressure; Humans; Masks; Nose; Retrospective Studies; Sleep Apnea, Obstructive

Topics: Adult; Humans; Maxilla; Nose; Osteogenesis, Distraction; Palatal Expansion Technique; Sleep Apnea, Obstructive

Continuous positive airway pressure (CPAP) remains the major treatment option for obstructive sleep apnea (OSA). The American Thoracic Society organized a workshop to discuss the importance of mask selection for OSA treatment with CPAP. In this workshop report, we summarize available evidence about the breathing route during nasal and oronasal CPAP and the importance of nasal symptoms for CPAP outcomes. We explore the mechanisms of air leaks during CPAP treatment and possible alternatives for leak control. The impact of nasal and oronasal CPAP on adherence, residual apnea-hypopnea index, unintentional leaks, and pressure requirements are also compared. Finally, recommendations for patient and partner involvement in mask selection are presented, and future directions to promote personalized mask selection are discussed.

Topics: Continuous Positive Airway Pressure; Humans; Masks; Nose; Sleep Apnea, Obstructive; United States

The study aimed to explore the method of constructing the upper respiratory tract model of patients with obstructive sleep apnoea hypopnoea syndrome (OSAHS) and its application in the detection of the changes of flow field characteristics of the upper respiratory tract before and after surgical treatment.. A 34-year-old male OSAHS patient was taken as the study subject. The improved Han-uvulopalato pharyngoplasty was adopted for treatment. A 3D model of the patient's upper respiratory tract was constructed based on CT scan results before and after surgery. The characteristics of upper respiratory tract flow field were analyzed based on computational hydrodynamics under unsteady respiratory conditions.. A 3D model of the patient's upper respiratory tract was successfully constructed. And after the comparison, it was found that the patients' respiratory tract stenosis was significantly improved after surgical treatment. During inhalation and exhalation, the high pressure areas of the patient were located in the nasal vestibule and oropharynx respectively. Surgical treatment can significantly reduce maximum stress. The total pressure of the upper respiratory tract decreased by 16.9%, and the pressure of the nasopharynx and oropharynx decreased by 70.1% and 38.4%, respectively.. For the oropharyngeal area, the surgical treatment had obvious efficacy for inspiration, and during expiration, it had no efficacy but with adverse symptoms being increased.

Topics: Adult; Humans; Hydrodynamics; Male; Nasopharynx; Nose; Pharynx; Sleep Apnea, Obstructive

Tongue motion patterns (TMP) can influence the outcome of upper airway stimulation (UAS) in the treatment of obstructive sleep apnea (OSA). As a postoperative control the cuff position of the stimulation lead is monitored via X‑ray imaging. A multidimensional X‑ray assessment system was established and the association between these positional assessments and TMP was investigated 1 year after implantation.. The study on TMP and the X‑ray assessments were carried out at a German ear nose and throat clinic as an implantation center. The TMPs were assessed under bipolar electrode configuration and were categorized according to the currently available literature as right-sided protrusion (RP), left-sided protrusion (LP), bilateral protrusion (BP) and mixed activation (MA). The X‑ray assessment was carried out in five dimensions: the position relative to the mandible and hyoid, cuff steepness in the lateral view of the neck, the cuff position based on the single electrode and the lead connection to the cuff in the anterior-posterior view. The analyses were performed by three raters with different medical backgrounds and knowledge regarding TMP.. In approximately 60% of the patients the apnea-hypopnea index was reduced to below 15/h, 1 year after implantation. The most common TMPs were RP and BP (82.9%). The interrater variability of the X‑ray assessment was good except for one category. Furthermore, no relevant associations were found apart from the correlation between a favorable TMP and the cuff position with respect to the lateral position of the stimulation cable.. Despite good interrater variability and convenient usage of the suggested X‑ray assessment system, this approach did not enable the identification of any associations, by which a TM and therefore a possible straightforward or complicated treatment pathway could be predicted. Attention should possibly be paid to a rotation of the cuff during implantation with a lateral position of the stimulation lead.

Topics: Electric Stimulation Therapy; Humans; Nose; Polysomnography; Sleep Apnea, Obstructive; Tongue

Topics: Humans; Insufflation; Nose; Polysomnography; Sleep Apnea, Obstructive

Oronasal breathing may adversely impact obstructive sleep apnea (OSA) patients either by increasing upper airway collapsibility or by influencing continuous positive airway pressure (CPAP) treatment outcomes. Predicting a preferential breathing route would be helpful to guide CPAP interface prescription. We hypothesized that anthropometric measurements but not self-reported oronasal breathing are predictors of objectively measured oronasal breathing. Seventeen OSA patients and nine healthy subjects underwent overnight polysomnography with an oronasal mask with two sealed compartments attached to independent pneumotacographs. Subjects answered questionnaires about nasal symptoms and perceived breathing route. Oronasal breathing was more common (

Topics: Adult; Airway Obstruction; Body Mass Index; Continuous Positive Airway Pressure; Female; Humans; Male; Middle Aged; Nose; Polysomnography; Respiration; Sleep; Sleep Apnea, Obstructive; Surveys and Questionnaires; Treatment Outcome

The aim of this investigation was to assess, with a descriptive three-dimensional evaluation, the volume of upper airway (UAWV) and the volume of craniofacial structures in adult patients suffering from obstructive sleep apnoea (OSA) and compare them to the corresponding findings in adults with no sleep disorders.. The sample consisted of 54 adult males, 27 suffering from OSA diagnosed by means of the Apnoea Hypopnea Index and 27 with no history of sleep disorders. All subjects had a cone beam computerized tomography scan performed with the same head position. UAWV was assessed with the Amira® software, and craniofacial volumes by means of a specially developed data-processing program, which allowed the construction of tetrahedrons using anatomical landmarks. Assessed volumes were naso-maxillary, cranium upper anterior, oral cavity, post-oral cavity, hyoid to mandible, and post-hyoid. SPSS (version 19.0) was used for the statistical analysis. The Levene's test for Equality of Variance, the t-test for Equality of Means and the Mann-Whitney test were used to evaluate the variables. The level of significance was set at P ≤ 0.05.. The mean value of UAWV was smaller in the OSA group. The post-hyoid volume, the calculated posterior volume, and the ratio of posterior to total volume showed differences between the groups.. Craniofacial structures did not show significant differences between the groups, but in the OSA group the posterior space released for upper airway was significantly bigger and UAWV was significantly smaller.

Topics: Adult; Anatomic Landmarks; Female; Humans; Hyoid Bone; Male; Mandible; Maxilla; Mouth; Nose; Pharynx; Sleep Apnea, Obstructive; Spiral Cone-Beam Computed Tomography

Lobl M, Zandieh SO. Obstructive sleep apnea as the first presentation of juvenile nasal angiofibroma. J Clin Sleep Med. 2019;15(9):1373-1375.

Topics: Adolescent; Angiofibroma; Humans; Magnetic Resonance Imaging; Male; Nose; Nose Neoplasms; Sleep Apnea, Obstructive

Obstructive sleep apnea (OSA) is a prevalent health problem. Developing a technology for quick OSA screening is momentous. In this study, we used regularized logistic regression to predict the OSA severity level of 199 individuals (116 males) with apnea/hypopnea index (AHI) ≥ 15 (moderate/severe OSA) and AHI < 5 (non-OSA) using their tracheal breathing sounds (TBS) recorded during daytime, while they were awake. The participants were guided to breathe through their nose, and then through their mouth at their deep breathing rate. The least absolute shrinkage and selection operator (LASSO) feature selection approach was used to select the discriminative features from the power spectra of the TBS and the anthropometric information. Using a five-fold cross-validation procedure, five different training sets and their corresponding blind-testing sets were formed. The average blind-testing classification accuracy over the five different folds was found to be 79.3% ± 6.1 with the sensitivity (specificity) of 82.2% ± 7.2% (75.8% ± 9.9%). The accuracy for the entire dataset was found to be 81.1% with sensitivity (specificity) of 84.4% (77.0%). The feature selection and classification procedures were intelligible and fast. The selected features were physiologically meaningful. Overall, the results show that TBS analysis can be used as a quick and reliable prediction of the presence and severity of OSA during wakefulness without a sleep study. Graphical abstract Wakefulness screening of obstructive sleep apnea using tracheal breathing sounds and anthropometric information by means of regularized logistic regression with the least absolute shrinkage and selection operator approach for feature selection and classification.

Topics: Adult; Anthropometry; Female; Humans; Logistic Models; Male; Middle Aged; Nose; Respiration; Respiratory Sounds; Sensitivity and Specificity; Sleep Apnea, Obstructive; Trachea; Wakefulness

Obstructive sleep apnoea hypopnoea syndrome associated with obesity poses major perioperative airway challenge. Drug-induced sleep endoscopy (DISE), is a real-time upper airway flexible fiberoptic nasoendoscopy in awake and sedation/anaesthesia-induced sleep. The aim of current study was to assess the correlation of bedside airway screening tests with level of obstruction during DISE.. Study was performed in endoscopy suite. Parameters calculated in 40 study group patients were Berlin questionnaire responses, Apnea hypopnea index (AHI), interincisor distance, Mallampati classification (MPC), neck circumference (NC), thyromental distance (TMD), NC/TMD ratio, sternomental distance (SMD), upper lip bite test, lateral cephalometry derived gonial angle and mentohyoid distance (MHD), Muller’s manoeuvre during awake nasoendoscopy, Croft–Pringle grade of airway obstruction during DISE and effect of jaw thrust.. All patients were American Society of Anesthesiologists physical status 1 and 2 with AHI > 30. Positive responses to Berlin questionnaire, body mass index and AHI increased with increasing grade of DISE. DISE grades 1–5 were observed in 0% (0), 5% (2), 37.5% (15), 27.5% (11) and 30% (12) patients respectively. Muller’s manoeuvre showed lateral wall collapse in 40% (16) patients and concentric collapse in 40% (16) patients. Airway patency improved with jaw thrust in 60% (24) patients. Significant association of DISE was found with MPC (p = 0.028), TMD (p = 0.003), MHD (p = 0.008) and NC/TMD ratio (p = 0.002), effect of Muller’s manoeuvre (p =0.002), and effect of jaw thrust (p = 0.000).. Bedside screening tests MPC, TMD, NC/TMD ratio and MHD correlate significantly with level of obstruction during DISE.

Topics: Adolescent; Adult; Aged; Airway Obstruction; Endoscopy; Female; Humans; Male; Middle Aged; Nose; Sleep; Sleep Apnea, Obstructive; Young Adult

Drug-induced sleep endoscopy (DISE) has gained interest for upper airway evaluation in patients with snoring and obstructive sleep apnea (OSA), and different drugs have been used to induce sedation. Nevertheless, all drugs have presented specific advantages and disadvantages with differential effects on respiratory physiology. This study evaluated and compared the effects of midazolam, propofol and dexmedetomidine on DISE findings, O. Case series prospective study.. Consecutive patients who elected to undergo surgery for OSA treatment and were intolerant to conservative therapies underwent DISE with propofol, dexmedetomidine, and midazolam between July 2015 and July 2016.. Fifty-two patients were analyzed, and 43 (82.7%) were men. Agreement among drugs for both degree and patterns of obstruction was excellent at all sites (velum, oropharynx, and epiglottis) except for the tongue base. Dexmedetomidine had the least complete collapse sites and highest O. Drug selection had a relevant influence in DISE findings. Compared with dexmedetomidine, midazolam and propofol presented higher incidence of tongue base collapse, lower O. 4 Laryngoscope, 129:506-513, 2019.

Topics: Adult; Dexmedetomidine; Endoscopy; Epiglottis; Female; Humans; Hypnotics and Sedatives; Male; Midazolam; Middle Aged; Nose; Oropharynx; Polysomnography; Propofol; Prospective Studies; Sleep; Sleep Apnea, Obstructive; Tongue; Young Adult

Endoscopic skull base surgery continues to evolve in its indications, techniques, instrumentation, and postoperative care. As surgery of the skull base will often violate dura, intraoperative and postoperative cerebrospinal fluid (CSF) leak is not uncommon and represents a potential conduit for air and bacterial contamination. Patients with obstructive sleep apnea (OSA) requiring continuous positive airway pressure (CPAP) therapy undergoing skull base surgery represent a challenging group. However, there appears to be a paucity of consensus regarding the postoperative management of this patient population. The objective of this study is to examine practice patterns and expert opinion on the use of postoperative CPAP and nasal saline in patients with OSA.. A 14-item survey was generated by consensus among expert authors and distributed online to members of the North American Skull Base society and other international skull base community members. Data were analyzed for median, mean, and standard deviation variables. Subgroup analysis was completed between surgeons from different geographical locations and operative experience. SPSS22 was utilized for all complex statistical analysis and figures.. Seventy-one responses were collected from skull base surgeons. In patients with OSA, respondents would resume patients' CPAP therapy after a mean of 10.1 days (median, 7; standard deviation [SD], 10.2), without a CSF leak. In the presence of a small CSF leak, the mean duration would increase to 14.3 days (median, 14; SD, 9.8) and to 20.7 days (median, 21; SD, 11.8) in the presence of a larger leak. A surgeon's choice to attribute the relationship between delaying the start of nasal saline and CPAP after the endoscopic skull base surgery with progressively more challenging skull base repair was found to be statistically significant ( P < .001).. Saline and CPAP therapies are initiated after the endoscopic skull base surgical repairs by surgeons at an increasing temporal delay in relation to the degree and complexity of the skull base defect repaired.

Topics: Canada; Cerebrospinal Fluid Leak; Continuous Positive Airway Pressure; Endoscopy; Fluid Therapy; Humans; Nose; Plastic Surgery Procedures; Postoperative Complications; Postoperative Period; Practice Patterns, Physicians'; Saline Solution; Skull Base; Sleep Apnea, Obstructive; Surveys and Questionnaires

In some severe skeletal Class III patients, mandibular setback surgery using sagittal split ramus osteotomy (SSRO) is performed to correct mandibular protrusion. However, in patients diagnosed with obstructive sleep apnea syndrome (OSAS), the risk of OSAS worsening as a result of the SSRO is very high. Maxillary advancement could reduce the degree of mandibular retropositioning and expand the skeletal framework in the pharyngeal region, leading to enlargement of the airway. However, nasal deformity is an undesirable outcome of the procedure. This case report describes a 23-year-old man with a retruded maxilla and OSAS. The maxillary retrusion was treated using Le Fort I osteotomy with an alar cinch suture and a muco-musculo-periosteal V-Y closure (ACVY). After treatment, better occlusal relationships and improvement in OSAS were observed. Thus, an ACVY could minimize nasolabial deformity.

Topics: Adult; Cephalometry; Humans; Male; Maxilla; Nose; Osteotomy, Le Fort; Osteotomy, Sagittal Split Ramus; Sleep Apnea, Obstructive; Sutures; Young Adult

Obstructive sleep apnea syndrome in childhood has aroused great interest due to its cardiovascular repercussions and its adverse effects on the quality of life of the affected individuals. However, fundamental aspects of the syndrome remain unknown.. Herein we prospectively assessed pulmonary artery systolic pressure (PASP) and nasal flow in children with obstructive oral breathing with an indication for adenoidectomy and/or tonsillectomy and their relationship to the obstructive apnea and hypopnea index (OAHI).. Twenty-one children were evaluated at the time of the surgical indication (T0) and 18 months later (T1). Polysomnography, and rhinomanometry data were collected when we evaluated PASP.. Among the 21 children, 13 (61.9%) presented an altered OAHI at T0. Fourteen children (66.7%) underwent surgery. Of these, nine (64.3%) had an altered OAHI at T0 and seven (50.0%) at T1. Of the seven non-operated children, four (57.1%) had an altered OAHI at T0 and two (33.3%) at T1. Mean nasal flow increased in both groups independently of surgery (p- ≤ 0.001). PASP exhibited a significant reduction between T0 and T1 in the operated group (p ≤ 0.001). OAHI of the operated group did not show a significant decrease over time (p = 0.074). In the non-operated children, the average nasal flow increased (p < 0.001), the PASP values did not reduce (p = 0.99), and the OAHI increased and then decreased over time (p = 0.025).. PASP decreased significantly and OAHI did not normalize in the operated group. Mean nasal airflow increased in the operated and non-operated groups.

Topics: Adenoidectomy; Blood Pressure; Child; Child, Preschool; Female; Humans; Male; Nose; Polysomnography; Prospective Studies; Pulmonary Artery; Respiration; Rhinomanometry; Severity of Illness Index; Sleep Apnea, Obstructive; Systole; Time Factors; Tonsillectomy

Patologie nasali in pazienti affetti da syndrome delle apnee ostruttive del sonno.. L’ostruzione nasale è una condizione frequentemente riportata in pazienti con sindrome delle apnee ostruttive del sonno (OSAS). L’ostruzione nasale porta alla respirazione orale, che si pensa possa destabilizzare le vie aeree superiori e aggravare l’OSAS. Tre condizioni potrebbero essere considerate come la causa dell’ostruzione respiratoria nasale: condizioni anatomiche nasali (deviazione del setto, ipertrofia dei turbinati inferiori), rinosinusite cronica (CRS) e infiammazione nasale cronica causata da rinite allergica o riniti non allergiche a cellularità. In questo studio prospettico presentiamo una valutazione di tutti questi possibili aspetti naso-sinusali in pazienti con OSAS al fine di correlare le diverse patologie nasali con l’ostruzione respiratoria nasale. Cinquanta pazienti con una diagnosi di OSAS sono stati arruolati nello studio. Nel 70% dei pazienti con OSAS, l’ostruzione nasale è stata confermata dalla valutazione clinica e dal test della respirazione con rinomanometria. Normali aspetti naso-sinusali erano presenti solo nel 20% dei pazienti con OSAS, mentre una o più condizioni patologiche naso-sinusali erano presenti nel restante 80%. L’incidenza di pazienti con OSAS con una diagnosi di rinite allergica e rinite non allergica era rispettivamente del 18% e del 26%. La rinite non allergica con neutrofili (NARNE) è stata la diagnosi più frequente nei pazienti con OSAS (20% dei casi). I risultati del presente studio supportano ed estendono l’osservazione che condizioni rinitiche sono presenti nei pazienti con OSAS. L’infiammazione della mucosa causata da queste condizioni potrebbe essere la causa della compromissione delle vie aeree superiori inducendo edema della mucosa nasale.. Nasal obstruction is a frequent condition in patients with obstructive sleep apnoea (OSA). Nasal obstruction leads to mouth breathing, which is thought to destabilise the upper airway and aggravate the condition. Three conditions could be considered as the cause of the nasal breathing obstruction: anatomical conditions of the nose (septum deviation, hypertrophy of the inferior turbinates), chronic rhinosinusitis (CRS) and chronic nasal inflammation caused by allergic rhinitis or non-allergic cellular rhinitis. In this prospective study, we present an evaluation of all these possible rhino-sinusal aspects in OSA patients to correlate different nasal pathologies with nasal obstruction. Fifty patients with a diagnosis of OSA were enrolled in the study. In 70% of OSA patients, nasal obstruction was confirmed by clinical evaluation and rhinomanometry testing. Normal rhino-sinus aspects were present in only 20% of OSA patients, whereas one or more pathological rhino-sinus conditions were present in the remaining 80%. The percentage of OSA patients with a diagnosis of allergic rhinitis and non-allergic rhinitis was 18% and 26% respectively. Non-allergic rhinitis with neutrophils (NARNE) was the most frequent type of cellular rhinitis diagnosed in OSA patients (20% of cases). The results of the present study support and extend the observation that rhinitis is present in OSA patients. Mucosal inflammation caused by these conditions could be the cause of upper airway patency impairment inducing nasal mucosa swelling.

Topics: Adult; Aged; Endoscopy; Female; Humans; Male; Middle Aged; Mucociliary Clearance; Nasal Obstruction; Nose; Regression Analysis; Rhinitis; Sleep Apnea, Obstructive

Topics: Cone-Beam Computed Tomography; Humans; Nose; Sleep Apnea, Obstructive

To assess the effect of distraction osteogenesis maxillary expansion (DOME) on objective parameters of the internal nasal valve and correlate findings with subjective outcomes.. Retrospective cohort study.. Tertiary referral center.. After Institutional Review Board approval, included subjects were those with obstructive sleep apnea, had undergone DOME from September 2014 to April 2018, and had cone beam computed tomography scans available before and after expansion. Measurement of the internal nasal valve parameters was performed with Invivo6 Software (version 6.0.3). Interrater reliability of all pre- and postexpansion parameters was measured. Patient-reported outcome measures included the Nasal Obstruction and Septoplasty Effectiveness Scale (NOSE) and Epworth Sleepiness Scale scores, and correlation between objective and subjective outcomes were evaluated by Spearman correlation analysis.. Thirty-two subjects met inclusion criteria. All showed significant improvement in their subjective outcomes as well as an increase in their internal valve parameters. Significant correlation was observed between increased angles and improvement in postexpansion NOSE score (right angle,. DOME widens the internal nasal valve objectively (dimensions), which correlates significantly with subjective improvement (NOSE scores).

Topics: Adolescent; Adult; Aged; Child; Cohort Studies; Female; Humans; Male; Middle Aged; Nasal Obstruction; Nose; Osteogenesis, Distraction; Palatal Expansion Technique; Retrospective Studies; Sleep Apnea, Obstructive; Young Adult

We hypothesized that computed tomography (CT) combined with portable polysomnography (PSG) might better visualize anatomic data related to obstructive sleep apnea (OSA). The present study evaluated the CT findings during OSA and assessed their associations with the PSG data and patient characteristics.. We designed a prospective cross-sectional study of patients with OSA. The patients underwent scanning during the awake state and apneic episodes. Associations of the predictor variables (ie, PSG data, respiratory disturbance index [RDI]), patient characteristics (body mass index [BMI], neck circumference [NC], and waist circumference [WC]), and outcome variables (ie, CT findings during apneic episodes) were assessed using logistic regression analysis. The CT findings during apneic episodes were categorized regarding the level of obstruction, single level (retropalatal [RP] or retroglossal [RG]) or multilevel (mixed RP and RG), degree of obstruction (partial or complete), and pattern of collapse (complete concentric collapse [CCC] or other patterns).. A total of 58 adult patients with OSA were scanned. The mean ± standard deviation for the RDI, BMI, NC, and WC were 41.6 ± 28.55, 27.80 ± 5.43 kg/m. An increased RDI appears to be an important variable for predicting the presence of complete obstruction and CCC during OSA. Scanning during apneic episodes, using low-dose volumetric CT combined with portable PSG provided better anatomic and pathologic findings of OSA than did scans performed during the awake state.

Topics: Adult; Body Mass Index; Cross-Sectional Studies; Humans; Nose; Pharynx; Polysomnography; Prospective Studies; Sleep Apnea, Obstructive; Tomography, X-Ray Computed

Topics: Adult; Continuous Positive Airway Pressure; Granulomatosis with Polyangiitis; Humans; Immunosuppressive Agents; Male; Masks; Nose; Nose Deformities, Acquired; Polysomnography; Sleep Apnea, Obstructive; Treatment Outcome; Weight Gain

Topics: Endoscopy; Humans; Nose; Sleep Apnea, Obstructive

It is unclear whether soft palate-associated changes in cephalometry associated with a mandibular advancement device (MAD) are independently associated with improvements in polysomnography (PSG) respiratory parameters in obstructive sleep apnea (OSA).. This retrospective review aimed to identify the association between soft palate-associated changes in cephalometry and PSG changes after application of an MAD. Korean patients diagnosed with OSA who underwent cephalometry with or without an MAD were enrolled. All the patients were evaluated after undergoing full-night PSG twice: once with an MAD and once without. Cephalometric findings were measured using an image analyzer.. Mean apnea-hypopnea index significantly decreased with an MAD from 36.4/h to 14.7/h (p < 0.001). Retropalatal airway space significantly increased with an MAD from 6.6 to 7.3 mm (p = 0.013). Soft palate length also significantly decreased with an MAD from 43.6 to 42.3 mm (p = 0.02). Although these findings were shown by responders (patients with a reduction of apnea-hypopnea index by more than 50%), there were no significant changes in non-responders. However, retroglossal airway space did not significantly increase with an MAD even in responders.. Improvement of OSA with an MAD can be predicted with soft palate-associated upper airway changes shown in cephalometry.

Topics: Adult; Aged; Cephalometry; Female; Humans; Larynx; Male; Mandibular Advancement; Middle Aged; Nose; Palate, Soft; Polysomnography; Retrospective Studies; Sleep Apnea, Obstructive

The purpose of this cross-sectional study is to examine the relationship between surgical treatments for sleep-disordered breathing (SDB) and composite measure of surgical complications in a nationally representative sample of hospital discharges among U.S. adults. We performed secondary analyses of 33,679 hospital discharges from the 2002-2012 Nationwide Inpatient Sample that corresponded to U.S. adults (≥18 years) who were free of head-and-neck neoplasms, were diagnosed with SDB and had undergone at least one of seven procedures. Multivariate logistic regression models were constructed to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI), controlling for age, sex, race/ethnicity, obstructive sleep apnea (OSA) and obesity diagnoses. Positive associations were found between composite measure of surgical complications and specific procedures: palatal procedure (aOR = 12.69, 95% CI: 11.91,13.53), nasal surgery (aOR = 6.47, 95% CI: 5.99,6.99), transoral robotic assist (aOR = 5.06, 95% CI: 4.34-5.88), tongue base/hypopharynx (aOR = 4.24, 95% CI: 3.88,4.62), maxillomandibular advancement (MMA) (aOR = 3.24, 95% CI: 2.74,3.84), supraglottoplasty (aOR = 2.75, 95% CI: 1.81,4.19). By contrast, a negative association was found between composite measures of surgical complications and tracheostomy (aOR = 0.033, 95% CI: 0.031,0.035). In conclusion, most procedures for SDB, except tracheostomy, were positively associated with complications, whereby palatal procedures exhibited the strongest and supraglottoplasty exhibited the weakest association.

Topics: Adolescent; Adult; Aged; Cross-Sectional Studies; Female; Hospitalization; Humans; Logistic Models; Male; Mandibular Advancement; Middle Aged; Nose; Obesity; Odds Ratio; Palate; Postoperative Complications; Risk Factors; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Tongue; Tracheostomy; United States; Young Adult

Mucopolysaccharide (MPS) diseases are a heterogeneous group of inherited, metabolic disorders characterized by accumulation of partially degraded glycosaminoglycans (GAG) in multiple organ systems. Due to accumulation in the airway, patients often present with multilevel airway obstruction and obstructive sleep apnoea (OSA). Adenotonsillar surgery leads to a significant improvement in the severity of OSA in MPS patients. However, access to secure the airway and for conventional surgery can be challenging, due to limited neck extension, macroglossia and reduced mouth opening. This study was undertaken to evaluate the role of transnasal microdebridement and radiofrequent plasma ablation (Coblation) in adenoidectomy to treat OSA in patients with MPS and restricted airway access.. A retrospective case review was performed including patients with MPS undergoing adenoidectomy for OSA in the period between June 2015 and March 2017. In all cases, either a microdebrider (Gyrus Diablo) or a Coblation wand (EVAC70, Smith&Nephew) was used via a transnasal approach guided by nasendoscopy. The primary outcome was effect upon OSA, measured by sleep oximetry and parental report of benefit. The secondary outcomes were surgical complications and risk factors for persistent OSA after surgery.. A total of nine patients were identified with a mean age of 9 years (range 3-14 years) at surgery. Post-operative sleep study data was available for eight patients (8/9). Six patients (6/8) had improvement in 4% oxygen desaturation index (ODI-4) with a mean of 8.11 pre-operatively (range 2.69-14.0) and 4.99 postoperatively (range 0.68-8.48). ODI-4 did not improve in two (2/8) patients. Irrespective of sleep oximetry results, improvement in OSA-related symptoms was noted by all parents postoperatively. No risk factors for persistent OSA were identified. Furthermore, no complications were noted in this cohort.. Transnasal Coblation and Microdebrider adenoidectomy is a safe and effective surgical treatment for OSA in patients with Mucopolysaccharidosis and adenoidal hypertrophy. As lifespan increases for patients with the Mucopolysaccharidoses, greater emphasis is being given to optimising airway management over the longer-term. This technical note describes the novel application of endoscopic techniques for the management of primary adenoidal hypertrophy when transoral access is restricted, or to debulk recurrent disease that would be challenging to remove via the standard transoral route.

Topics: Adenoidectomy; Adolescent; Catheter Ablation; Child; Child, Preschool; Debridement; Female; Humans; Male; Mucopolysaccharidoses; Natural Orifice Endoscopic Surgery; Nose; Retrospective Studies; Sleep Apnea, Obstructive; Treatment Outcome

To establish how assessment of adenoid size is correlated between drug-induced sleep endoscopy (DISE) with indirect mirror nasopharyngoscopy (IMN).. Retrospective chart review.. Tertiary care academic hospital.. Over a 6-year period, 154 pediatric patients underwent DISE for obstructive sleep apnea and had IMN. DISE videos were assessed by one reviewer, blinded to results of mirror exams. IMN findings were taken from operative notes recorded by one attending physician. Demographic data, co-morbidities, and sleep study results were also recorded.. Ninety-three (58.5%) males and 66 (41.5%) females were included. Mean age at DISE was 7.34 ± 3.99 years, with an average of 29 days after DISE until nasopharyngeal mirror examination. The mean initial adenoid size based on DISE assessment was 2.62 + 0.99, and on nasopharyngeal mirror assessment was 2.56 + 0.97. DISE and IMN assessment of adenoid size correlated well (Spearman's Rho = 0.82, P < 0.00001; Kendal tau = 0.764, P < 0.00001).. DISE has proven to be an excellent tool to assess adenoid size prior to adenoidectomy in children with OSA.

Topics: Adenoidectomy; Adenoids; Adolescent; Child; Child, Preschool; Comorbidity; Diagnostic Techniques, Respiratory System; Endoscopy; Female; Humans; Hypertrophy; Hypnotics and Sedatives; Infant; Male; Nasopharynx; Nose; Organ Size; Pharynx; Physical Examination; Propofol; Retrospective Studies; Sleep; Sleep Apnea, Obstructive

Despite reports of lower positive pressure adherence rates with oronasal masks, patients with sinonasal problems are often prescribed this interface over a nasal interface. The aim of this study was to characterize the relationship between mask type and therapy adherence in the setting of sinonasal symptoms.. Retrospective case series with chart review.. We reviewed 328 patients who underwent positive pressure titration between January 2012 and May 2015. Follow-up adherence data were available for 218 patients (66.5%). Multivariate analysis examined whether patients with sinonasal symptoms have improved adherence with oronasal masks compared to nasal or nasal pillow interfaces.. At a median follow-up of 95 days, positive pressure adherence in patients with sinonasal symptoms was highest with the nasal pillow interface. When compared with oronasal interfaces, the odds of adequate therapy adherence were >5 times greater with nasal pillow interfaces (odds ratio [OR] = 5.20, 95% confidence interval [CI] = 1.61-16.80, P = .006) and >3 times greater with nasal interfaces (OR = 3.67, 95% CI = 1.20-11.26, P = .02) in these symptomatic patients.. The presence of nasal problems does not predict the need for an oronasal mask. Positive pressure adherence rates are higher with nasal and nasal pillow interfaces compared to oronasal masks, even in patients with sinonasal complaints.. 4. Laryngoscope, 127:2418-2422, 2017.

Topics: Continuous Positive Airway Pressure; Equipment Design; Female; Humans; Male; Masks; Middle Aged; Nose; Paranasal Sinuses; Patient Compliance; Polysomnography; Pressure; Respiration; Retrospective Studies; Sleep Apnea, Obstructive

The aim of this study was to develop a predictive model of objective oropharyngeal obstructive sleep apnea (OSA) surgery outcomes including success rate and apnea-hypopnea index (AHI) reduction ratio in adult OSA patients.. Retrospective outcome research.. All subjects with OSA who underwent oropharyngeal and/or nasal surgery and were followed for at least 3 months were enrolled in this study. Demographic, anatomical [tonsil size (TS) and palate-tongue position (PTP) grade (Gr)], and polysomnographic parameters were analyzed. The AHI reduction ratio (%) was defined as [(postoperative AHI-preoperative AHI) x 100 / postoperative AHI], and surgical success was defined as a ≥ 50% reduction in preoperative AHI with a postoperative AHI < 20.. A total of 156 consecutive OSAS adult patients (mean age ± SD = 38.9 ± 9.6, M / F = 149 / 7) were included in this study. The best predictive equation by Forward Selection likelihood ratio (LR) logistic regression analysis was: [Formula: see text]The best predictive equation according to stepwise multiple linear regression analysis was: [Formula: see text] (TS/PTP Gr = 1 if TS/PTP Gr 3 or 4, TS/PTP Gr = 0 if TS/PTP Gr 1 or 2).. The predictive models for oropharyngeal surgery described in this study may be useful for planning surgical treatments and improving objective outcomes in adult OSA patients.

Topics: Adult; Decision Making, Computer-Assisted; Feasibility Studies; Female; Humans; Likelihood Functions; Linear Models; Logistic Models; Male; Nose; Oropharynx; Polysomnography; Prognosis; Retrospective Studies; Sleep Apnea, Obstructive; Treatment Outcome

One of the challenges of surgery for obstructive sleep apnea (OSA) is identifying the correct surgical site for each patient. The objective of this study was to use drug-induced sleep endoscopy (DISE) and nasopharyngeal tube (NPT) placement to determine the effect of eliminating palatal collapse on the obstruction seen on other segments of the upper airway.. Forty-one OSA patients were enrolled in this prospective study. All patients had a polysomnogram followed by DISE. DISE findings were recorded and compared with and without placement of a NPT. Obstruction was graded with a scale that incorporates location, severity, and interval of obstruction.. Most patients (83%) demonstrated multilevel obstruction on initial DISE. With the nasopharyngeal airway in place, many patients with multilevel obstruction had at least a partial improvement (74%) and some a complete resolution (35%) of collapse (p < 0.05). Reduction in collapse was observed at the lateral walls (86%), epiglottis (55%), and tongue base (50%). NPT placement did not significantly alter upper airway morphology of patients with incomplete palatal obstruction or mild OSA.. To our knowledge, this is the first study to evaluate the effect of soft palatal stenting on downstream pharyngeal obstruction during DISE. Our study provides evidence that reducing soft palatal collapse can reduce negative pharyngeal pressure and thereby alleviate other sites of upper airway obstruction. Taken together, these findings provide a means to identify appropriate candidates for isolated palatal surgery and better direct a minimally invasive approach to the surgical management of OSA.

Topics: Adult; Aged; Airway Obstruction; Endoscopy; Female; Humans; Hypnotics and Sedatives; Male; Middle Aged; Nose; Palate; Pharynx; Prospective Studies; Sleep; Sleep Apnea, Obstructive; Young Adult

This study aimed to evaluate subjective symptom changes in obstructive sleep apnoea hypopnea syndrome patients following nasal surgery, and to explore treatment efficacy in improving patient quality of life.. Patients with nasal blockage accompanied by habitual snoring were stratified into four groups. Their subjective symptoms were evaluated before and after nasal surgery.. There was a significant decrease in the nasal blockage symptom visual analogue scale, Epworth Sleepiness Scale, Snore Outcomes Survey, Spouse/Bed Partners Survey and Sino-Nasal Outcome Test 20 scores for all patients at six months after surgery. The visual analogue scale score for subjective olfactory function was significantly improved in the severe obstructive sleep apnoea hypopnea syndrome patient group.. Nasal surgery can effectively improve the subjective symptoms of patients with simple snoring accompanied by nasal blockage and of patients with obstructive sleep apnoea hypopnea syndrome, thus improving their quality of life.

Topics: Adolescent; Adult; Female; Humans; Male; Middle Aged; Nasal Obstruction; Nose; Polysomnography; Quality of Life; Severity of Illness Index; Sleep Apnea, Obstructive; Smell; Snoring; Treatment Outcome; Visual Analog Scale; Young Adult

Objective Assess the frequency and nature of postoperative complications following sleep surgery. Examine these issues specifically in elderly patients to provide guidance for their perioperative care. Study Design Retrospective cohort study. Setting American College of Surgeons National Surgical Quality Improvement Program. Methods We identified patients with obstructive sleep apnea undergoing sleep surgery procedures from 2006 to 2013 in the American College of Surgeons National Surgical Quality Improvement Program, a multi-institutional outcomes program designed to improve surgical quality. We analyzed patients by comparing age groups: <65 and ≥65 years. Summary data were analyzed, and multivariate regression was used to adjust for patient characteristics, comorbidities, and surgical procedure. Results We identified 2230 patients who had sleep surgery, which included 2123 patients <65 years old and 107 patients ≥65 years old. Elderly patients were significantly more likely to have hypertension requiring medication ( P < .001) and higher American Society of Anesthesiologists scores ( P < .001). There were no significant differences in the rates of nasal ( P = .87), palate ( P = .59), tongue base ( P = .73), and multilevel ( P = .95) surgery being performed on both groups of patients. Elderly patients had higher rates of wound complications and urinary tract infections as compared with younger patients. On multivariate analysis, age ≥65 was significantly associated with complications from sleep surgery (odds ratio, 2.35; 95% CI, 1.04-5.35). Conclusion Elderly patients undergoing sleep surgery have increased postoperative complication risk as compared with younger patients treated similarly. This information can help direct quality improvement efforts in the care of older patients.

Topics: Adult; Age Factors; Aged; Female; Humans; Incidence; Male; Nose; Otorhinolaryngologic Surgical Procedures; Palate, Soft; Postoperative Complications; Quality Improvement; Retrospective Studies; Sleep Apnea, Obstructive; Tongue

We conducted a retrospective study to evaluate the short-term effect of uvulopalatopharyngoplasty (UPPP) on changes in the nasalance of five vowels: /a/, /ε/, /i/, /ɔ/, and /u/. Our study group was made up of 20 patients-15 males and 5 females, aged 16 to 57 years (mean: 37.3 ± 11.5)-who had undergone UPPP as a treatment for mild to moderate obstructive sleep apnea. Nasometry was used to obtain nasalance scores in all patients on the morning of the operation (day 1) and subsequently on day 4 or 5 (mean: 4.5 ± 0.5). Preoperatively, nasalance scores were highest for /i/ (mean: 29.8 ± 12.6) and /a/ (mean: 24.1 ± 10.3). After the operation, nasalance scores for all five studied vowels increased; they were highest for /i/ (mean: 40.7 ± +17.8) and /ε/ (mean: 30.0 ± 10.8). The increases in the nasalance of /i/, /ε/, and /u/ were statistically significant (p < 0.05). Our findings indicate that UPPP has a significant impact on nasalance immediately after surgery.

Topics: Adolescent; Adult; Articulation Disorders; Female; Humans; Male; Middle Aged; Nose; Otorhinolaryngologic Surgical Procedures; Palate, Soft; Pharynx; Phonetics; Postoperative Complications; Postoperative Period; Retrospective Studies; Sleep Apnea, Obstructive; Speech; Speech Production Measurement; Time Factors; Uvula; Young Adult

The choice of mask interface used with continuous positive airway pressure (CPAP) therapy can affect the control of upper airway obstruction (UAO) in obstructive sleep apnea (OSA). We describe a case series of four patients with paradoxical worsening of UAO with an oronasal mask and the effect of changing to a nasal mask.. We retrospectively reviewed the case histories of 4 patients and recorded patient demographics, in-laboratory and ambulatory CPAP titration data, CPAP therapy data, type of mask interface used and potential confounding factors.. The 4 cases (mean ± SD: age = 59 ± 16 y; BMI = 30.5 ± 4.5 kg/m(2)) had a high residual apnoea-hypopnea index (AHI) (43 ± 14.2 events/h) and high CPAP pressure requirements (14.9 ± 6.6 cmH2O) with an oronasal mask. Changing to a nasal mask allowed adequate control of UAO with a significant reduction in the average residual AHI (3.1 ± 1.5 events/h). In two of the four cases, it was demonstrated that control of UAO was obtained at a much lower CPAP pressure compared to the oronasal mask (Case one = 17.5 cmH2O vs 12cmH2O; Case two = 17.9 cmH2O vs 7.8 cmH2O). Other potential confounding factors were unchanged. There are various physiological observations that may explain these findings but it is uncertain which individuals are susceptible to these mechanisms.. If patients have OSA incompletely controlled by CPAP with evidence of residual UAO and/or are requiring surprisingly high CPAP pressure to control OSA with an oronasal mask, the choice of mask should be reviewed and consideration be given to a trial of a nasal mask.. A commentary on this article appears in this issue on page 1209.

Topics: Adult; Aged; Airway Obstruction; Continuous Positive Airway Pressure; Equipment Design; Female; Humans; Male; Masks; Middle Aged; Nose; Oropharynx; Polysomnography; Retrospective Studies; Sleep Apnea, Obstructive

The aim of this work was to evaluate the correlation between Apnea/Hypopnea Index (AHI) and selected parameters of morphological and clinical character in the patients with a unilateral or bilateral impairment of nasal patency.. The study covered 60 adults, including 37 male and 23 female subjects, 19-69 years of age. In the Department, these subjects were divided into 3 groups: I - 20 patients with unilateral impairment of nasal patency, II - 20 patients with bilateral impairment of nasal patency, III - controls with normal nasal patency.. A subjective examination (questionnaire with a sleepiness scale), an objective examination (general examination of the neck and waist diameter, body weight, height, length of the uvula), otorhinolaryngological examination (Pirquet test of the palatine tonsils), X-ray and CT of the head and paranasal sinuses) to determine the cause and location of the obturation of air passages, physiological tests and polysomnography. The correlations between the neck circumferenceheight ratio (NHR) and AHI, waist-hip ratio (WHR) and AHI. The statistical analysis of the study results was conducted in Stata®/Special Edition Program, 14.1 version (StataCorp LP, College Station, Texas, USA).. Clinically, the study group revealed: shallow breathing in 47.5% and apnea in 52.5% of the studied patients whereas the control group did not show any sleep disorders. Statistical fluctuations between controls and the study groups were noticed (p<0.001).. By the Epworth scale, moderate and severe sleepiness was found in merely 12.5% of the patients. The differences in the length of the uvula and the size of the pharyngeal tonsils between the studied groups were not statistically significant. No statistical significance was found between NHR and AHI, BMI and AHI, WHR and AHI in the studied group.

Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Nose; Palatine Tonsil; Sleep Apnea, Obstructive; Surveys and Questionnaires; Young Adult

Oronasal masks are frequently used for continuous positive airway pressure (CPAP) treatment in patients with obstructive sleep apnea (OSA). The aim of this study was to (1) determine if CPAP requirements are higher for oronasal masks compared to nasal mask interfaces and (2) assess whether polysomnography and patient characteristics differed among mask preference groups.. Retrospective analysis of all CPAP implementation polysomnograms between July 2013 and June 2014. Prescribed CPAP level, polysomnography results and patient data were compared according to mask type (n = 358).. Oronasal masks were used in 46%, nasal masks in 35% and nasal pillow masks in 19%. There was no difference according to mask type for baseline apnea-hypopnea index (AHI), body mass index (BMI), waist or neck circumference. CPAP level was higher for oronasal masks, 12 (10-15.5) cm H2O compared to nasal pillow masks, 11 (8-12.5) cm H2O and nasal masks, 10 (8-12) cm H2O, p < 0.0001 (Median [interquartile range]). Oronasal mask type, AHI, age, and BMI were independent predictors of a higher CPAP pressure (p < 0.0005, adjusted R(2) = 0.26.). For patients with CPAP ≥ 15 cm H2O, there was an odds ratio of 4.5 (95% CI 2.5-8.0) for having an oronasal compared to a nasal or nasal pillow mask. Residual median AHI was higher for oronasal masks (11.3 events/h) than for nasal masks (6.4 events/h) and nasal pillows (6.7 events/h), p < 0.001.. Compared to nasal mask types, oronasal masks are associated with higher CPAP pressures (particularly pressures ≥ 15 cm H2O) and a higher residual AHI. Further evaluation with a randomized control trial is required to definitively establish the effect of mask type on pressure requirements.. A commentary on this article appears in this issue on page 1209.

Topics: Australia; Continuous Positive Airway Pressure; Equipment Design; Female; Humans; Male; Masks; Middle Aged; Nose; Polysomnography; Pressure; Retrospective Studies; Sleep Apnea, Obstructive; Treatment Outcome

Characterizing respiratory rate variability (RRV) in humans during sleep is challenging, since it requires the analysis of respiratory signals over a period of several hours. These signals are easily distorted by movement and volitional inputs. We applied the method of spectral analysis to the nasal pressure transducer signal in 38 adults with no obstructive sleep apnea, defined by an apnea-hypopnea index <5, who underwent all-night polysomnography (PSG). Our aim was to detect and quantitate RRV during the various sleep stages, including wakefulness. The nasal pressure transducer signal was acquired at 100 Hz and consecutive frequency spectra were generated for the length of the PSG with the Fast Fourier Transform. For each spectrum, we computed the amplitude ratio of the first harmonic peak to the zero frequency peak (H1/DC), and defined as RRV as (100 - H1/DC) %. RRV was greater during wakefulness compared to any sleep stage, including rapid-eye-movement. Furthermore, RRV correlated with the depth of sleep, being lowest during N3. Patients spent most their sleep time supine, but we found no correlation between RRV and body position. There was a correlation between respiratory rate and sleep stage, being greater in wakefulness than in any sleep stage. We conclude that RRV varies according to sleep stage. Moreover, spectral analysis of nasal pressure signal appears to provide a valid measure of RRV during sleep. It remains to be seen if the method can differentiate normal from pathological sleep patterns.

Topics: Adult; Female; Fourier Analysis; Humans; Male; Middle Aged; Movement; Nose; Polysomnography; Posture; Pressure; Respiratory Rate; Retrospective Studies; Sleep; Sleep Apnea, Obstructive; Sleep Stages; Sleep, REM; Volition; Wakefulness

Obstructive sleep apnoea syndrome (OSAS) is a sleep disorder that leads to metabolic abnormalities and increased cardiovascular risk. This study aimed to define the expression and clinical significance of biomarkers involved in oxidative stress in patients with OSAS. A prospective study was designed to compare outcomes of oxidative stress laboratory tests in three groups of subjects. The study involved the recruitment of three groups of subjects, 10 patients with obstructive sleep apnoea syndrome with AHI > 30; 10 patients suffering from snoring at night with AHI < 15; 10 patients with nasal respiratory impairment with AHI < 5. Patients were subjected to skin prick tests for common aero-allergens, nasal endoscopy, active anterior rhinomanometry, fibrolaryngoscopy and polysomnography; and extra-routine diagnostic tests and procedures; analysis of oxidative and antioxidant (plasma thiol groups) biomarkers in blood and urine samples. No statistical differences in age, sex distribution or body mass index were present between the three groups (p > 0.05). There were significant differences in AHI among the three groups of patients (p < 0.05). No statistical significance was found in the Analysis of Variance (ANOVA) test (p > 0.05) between the levels of biomarkers of oxidative stress in the three populations studied. The results of our study show that the nose can play a role in the pathogenesis of OSAS through the production of biomarkers of oxidative stress.. La sindrome delle apnee ostruttive del sonno (OSAS) è una malattia che può portare ad alterazioni metaboliche e a un’aumentata incidenza di patologie cardiovascolari. Questo studio ha lo scopo di definire l’espressione e il significato clinico di biomarkers coinvolti nello stress ossidativo nei pazienti con diagnosi di OSAS. I risultati degli esami di laboratorio dello stress ossidativo sono stati confrontai prospetticamente in tre gruppi di soggetti: 10 con sindrome delle apnee ostruttiva del sonno con Apnea Hypopnea Index (AHI) > 30; 10 con roncopatia notturna e AHI < 15 e 10 con insufficienza respiratoria nasale e AHI < 5. I pazienti sono stati sottoposti a test cutanei per aero-allergeni comuni, rinoscopia anteriore, rinomanometria anteriore attiva, fibrolaringoscopia e polisonnografia. Per la ricerca dei biomarkers dello stress ossidativo sono stati effettuati test diagnostici in campioni di sangue e urine. I gruppi sono risultati omogenei per età, sesso e distribuzione del Body Mass Index (BMI) (p > 0.05). Ci sono state differenze significative nell’AHI tra i tre gruppi di pazienti (p < 0.05). Nessuna significatività statistica è stata identificata (p > 0.05) tra i livelli di biomarkers di stress ossidativo nelle tre popolazioni studiate. I risultati del nostro studio hanno mostrato che il naso può svolgere un ruolo nella patogenesi dell’ OSAS, attraverso la produzione di biomarkers di stress ossidativo.

Topics: Adult; Female; Humans; Male; Nose; Oxidative Stress; Prospective Studies; Respiration Disorders; Sleep Apnea, Obstructive; Snoring

Topics: Continuous Positive Airway Pressure; Craniofacial Abnormalities; Humans; Nasal Obstruction; Nose; Oxygen; Patient Compliance; Sleep Apnea, Obstructive

This guideline aims to promote high-quality care by medical specialists for subjects who snore and is designed for everyone involved in the diagnosis and treatment of snoring in an in- or outpatient setting.. To date, a satisfactory definition of snoring is lacking. Snoring is caused by a vibration of soft tissue in the upper airway induced by respiration during sleep. It is triggered by relaxation of the upper airway dilator muscles that occurs during sleep. Multiple risk factors for snoring have been described and snoring is of multifactorial origin. The true incidence of snoring is not clear to date, as the incidence differs throughout literature. Snoring is more likely to appear in middle age, predominantly in males. Diagnostic measures should include a sleep medical history, preferably involving an interview with the bed partner, and may be completed with questionnaires. Clinical examination should include examination of the nose to evaluate the relevant structures for nasal breathing and may be completed with nasal endoscopy. Evaluation of the oropharynx, larynx, and hypopharynx should also be performed. Clinical assessment of the oral cavity should include the size of the tongue, the mucosa of the oral cavity, and the dental status. Furthermore, facial skeletal morphology should be evaluated. In select cases, technical diagnostic measures may be added. Further objective measures should be performed if the medical history and/or clinical examination suggest sleep-disordered breathing, if relevant comorbidities are present, and if the subject requests treatment for snoring. According to current knowledge, snoring is not associated with medical hazard, and generally, there is no medical indication for treatment. Weight reduction should be achieved in every overweight subject who snores. In snorers who snore only in the supine position, positional treatment can be considered. In suitable cases, snoring can be treated successfully with intraoral devices. Minimally invasive surgery of the soft palate can be considered as long as the individual anatomy appears suitable. Treatment selection should be based on individual anatomic findings. After a therapeutic intervention, follow-up visits should take place after an appropriate time frame to assess treatment success and to potentially indicate further intervention.

Topics: Adult; Airway Obstruction; Algorithms; Cooperative Behavior; Endoscopy; Germany; Humans; Interdisciplinary Communication; Mandibular Advancement; Nasopharynx; Nose; Occlusal Splints; Otorhinolaryngologic Surgical Procedures; Polysomnography; Sleep Apnea, Obstructive; Snoring; Sound Spectrography; Tomography, Optical Coherence

The aim of this study was to investigate the relationship between nasal structure and olfactory function in patients with obstructive sleep apnea (OSA). Olfaction and nasal structure of 76 adults with OSA diagnosed by polysomnography were measured using acoustic rhinometry and the Sniffin, Sticks (SS) smell test at Anzhen Hospital, a major academic center in Beijing, China. We tested the hypothesis that nasal structure in these patients would correlate with objectively measured olfactory performance. Minimum cross-sectional area (MCA) of the nose was significantly correlated with SS composite score (r = 0.434, p < 0.001), a result that was driven by two of the test's three components: olfactory threshold (OT) (r = 0.385, p = 0.001) and olfactory discrimination (OD) (r = 0.370, p = 0.001) but not olfactory identification (OI) (p > 0.05). Additionally, nasal volume (NV) was associated with composite SS score (r = 0.350, p = 0.002), a finding driven by OT (r = 0.283, p = 0.014). These data suggest that nasal structure affects parameters of olfactory function, likely via alterations in nasal airflow. Thus, anatomic abnormalities and diseases involving airflow (such as OSA) may cause, in part, olfactory dysfunction that is amenable to treatment. We speculate that surgery that alters nasal volume and MCA may improve olfactory performance.

Topics: Adult; Age Factors; Body Mass Index; Female; Humans; Male; Middle Aged; Nose; Olfactory Perception; Polysomnography; Rhinometry, Acoustic; Sex Factors; Sleep Apnea, Obstructive; Smell; Smoking

Topics: Continuous Positive Airway Pressure; Female; Humans; Male; Nose; Pressure; Sleep Apnea, Obstructive

The aim of the present study was to investigate if any of the three awake procedures [fiberoptic nasopharyngoscopy with modified Müller Maneuver (FNMM), nasal snoring endoscopy (NSE), or oral snoring endoscopy (OSE)] could efficiently predict the grade or pattern of upper airway (UA) collapse found with drug-induced sleep endoscopy (DISE), which is considered by many authors as the current gold standard in optimizing obstructive sleep apnea syndrome (OSAS) patient selection for UA surgery. Twenty consecutive patients (simple snorers and OSAS patients) were studied with FNMM, NSE, OSE, and DISE. The inter-test agreement was evaluated with Cohen's kappa coefficient (κ). In the current series, we found that NSE and OSE were better than FNMM in predicting the pattern of collapse found with DISE. A significant pattern agreement between NSE and DISE was present in all sub-sites, and the agreement was measured with a scale proposed by Landis and Koch as: moderate in velo- and oropharynx (κ = 0.52, p = 0.001, and κ = 0.47, p = 0.003, respectively), and substantial in hypopharynx (κ = 0.63, p < 0.00001). Comparing OSE with DISE, the pattern agreement was almost perfect at oropharyngeal level (κ = 0.82, p < 0.00001), and moderate at hypopharyngeal level (κ = 0.55, p = 0.0002); while a trend towards significance was found at velopharyngeal level (κ = 0.20, p = 0.07). FNMM showed a fair pattern agreement with DISE only at oropharyngeal level (κ = 0.31, p = 0.009); while in the other sub-sites, no significant agreement was found. NSE and OSE are new promising diagnostic tools in OSAS patients. Further investigations are needed to see if they could predict the effectiveness of UA surgery.

Topics: Anesthetics, Intravenous; Endoscopy; Female; Fiber Optic Technology; Humans; Male; Middle Aged; Nose; Patient Selection; Pharynx; Propofol; Reproducibility of Results; Severity of Illness Index; Sleep Apnea, Obstructive; Snoring

To investigate the anatomy of the upper airway (UA) of a representative sample of the adult population of São Paulo city, Brazil, and to identify factors associated with the presence of obstructive sleep apnea syndrome (OSAS), as confirmed using full-night polysomnography (PSG).. Cross-sectional study.. Population-based sample.. A 3-stage sampling procedure was used to proportionally recruit adult residents of São Paulo city according to gender, age, and socioeconomic status. A complete evaluation was performed, including a systematic evaluation of the UA prior to conducting PSG.. Nine-hundred ninety-three (90.2%) of the participants were seen by an ear, nose, and throat (ENT) specialist. Individuals who were diagnosed with OSAS (32.9%) presented a higher frequency of nasal symptoms and structural abnormalities (both nasal and oropharyngeal) compared with those without OSAS. No anatomical differences were observed in the facial skeleton. An abnormal nasal structure visible via anterior rhinoscopy was the only UA factor predicting OSAS after adjustments for the other common OSAS risk factors (male sex, aging, obesity, and increased neck circumference).. This is the first study in which a systematic evaluation of the UA was followed by a sleep study in a population-based sample. In a sample of the general population that had not previously been screened for OSAS, having an abnormal nasal structure was found to be a risk factor for OSAS, in conjunction with other well-established clinical and demographic factors, such as male gender, increased age, increased neck circumference, and body mass index.

Topics: Adult; Cross-Sectional Studies; Female; Humans; Male; Mouth Abnormalities; Nose; Oropharynx; Polysomnography; Risk Factors; Sleep Apnea, Obstructive

To investigate the therapeutic effects of oral modified device combined with nasopharyngeal enlargement surgery and evaluate the oral modified device' s adjuvant therapy meaning in severe OSAHS patients after surgery treatment.. 46 cases with severe OSAHS were diagnosed by PSG according to AHI and the lowest arterial oxygen saturation (LSaO2). We performed the nasal or pharyngeal cavity expansion surgery for them according to the pathological change part correspondingly. Then all subjects were divided into combined group (n=26) and surgery alone group (n=20) according to their personal willingness. We monitored the PSG for all subjects aftter 2 weeks and 3 months respectively, then we calculate the diversity between the two group or intragroup change on the basis of the AHI, LAT, LSaO2, mean arterial oxygen saturation (MSaO2) and sleep structures recorded by PSG. At the same time, we collected the subjective sensations by questionnaire.. The AHI and LAT in combined group were significantly lower and LSaO2 was significantly higher than these in surgery alone group(P<0. 05), and it's no difference in MSO2 between the two groups (P>0. 05). The N 1% was more shorter and the N2% and N3% were more longer after nasal or pharyngeal operation compared with pre-operative states in both groups(P<. 05), but we didn't find difference in REM%(P>. 05). The data of PSG also showed that the shallow sleep proportion was more shorter and the slow wave sleep proportion was more longer in combined group compared with surgery alone group. The subjective sensations results also showed significantly alleviated in combined group, such as mental state, daytime sleepiness and physical strength. The efficiency ratio of treatment was 85. 0% and 92. 3% in surgery alone group and combined group respectively.. Nasal and pharyngeal cavity enlargement surgery combined with oral modified device is a more effective treatment in patients with severe OSAHS, and it is meaningful for the long-term curative effect of surgery to prevent relapse and improve.

Topics: Humans; Nasopharynx; Nose; Otorhinolaryngologic Surgical Procedures; Oximetry; Sensation; Sleep; Sleep Apnea, Obstructive; Sleep Stages; Treatment Outcome

To determine whether identification and incorporation of the pyriform ligament in the alar cinch results in decreased alar base widening compared with standard alar cinch techniques.. This was a retrospective case series and the sample was composed of patients undergoing Le Fort I osteotomy. Intraoperatively, the pyriform ligament was identified and incorporated in the alar cinch suture. Greatest alar width (GAW) measured immediately after closure was compared with GAW measured at least 5 months postoperatively. The change in alar base width was compared with that reported in the literature using other alar cinch techniques. Two case examples are reported.. The sample was composed of 15 patients (mean age, 27.1 yr; 27% female). The mean postoperative change in GAW was 1.0 ± 0.6 mm (2.59 ± 1.59%). Postoperative change in alar base width reported in the literature ranged from 0.5 to 10.8%.. The pyriform ligament is easily identified during exposure of the maxilla and pyriform aperture and can be used to control widening of the alar base after Le Fort I osteotomy.

Topics: Adolescent; Adult; Cephalometry; Fasciotomy; Female; Follow-Up Studies; Humans; Ligaments; Male; Malocclusion, Angle Class III; Maxilla; Middle Aged; Nasal Bone; Nasal Cartilages; Nasal Mucosa; Nose; Osteotomy, Le Fort; Retrospective Studies; Sleep Apnea, Obstructive; Suture Techniques; Young Adult; Zygoma

Topics: Continuous Positive Airway Pressure; Female; Humans; Male; Nose; Patient Compliance; Sleep Apnea, Obstructive

To evaluate the impact of combined nasal surgery and endoscopic sinus surgery on the objective measurements of obstructive sleep apnea (OSA) and sleep architecture by comparing polysomnographic data before and after combined surgery in patients with OSA.. Case series with chart review.. A single clinical site.. Patients with OSA and chronic rhinosinusitis who underwent combined nasal surgery and endoscopic sinus surgery and preoperative and postoperative polysomnography were identified. Patient charts were reviewed and preoperative and postoperative body mass index, apnea-hypopnea index (AHI), mean and minimum oxygen saturation, sleep efficiency, and sleep staging were compared.. Fifty-six patients were included in our study. Patients were divided into 3 groups on the basis of the severity of OSA: those with mild OSA (n = 9), those with moderate OSA (n = 23), and those with severe OSA (n = 24). After combined nasal and sinus surgery, the mean AHI significantly decreased from 33.5 ± 22.0 to 29.4 ± 20.8 (P = .009) in our overall population. Specifically, AHI improved significantly in patients with moderate OSA (from 22.3 ± 4.8 to 20.7 ± 8.2, P = .023) and severe OSA (from 52.3 ± 21.4 to 43.6 ± 23.9, P = .034), while patients with mild OSA did not have significant changes in AHI. Successful surgical procedures were achieved in only 2 of 56 patients.. Although combined nasal and sinus surgery may slightly improve AHI in a certain group of patients, it does not cure OSA or have a significant clinical impact.

Topics: Adult; Body Mass Index; Female; Humans; Male; Middle Aged; Natural Orifice Endoscopic Surgery; Nose; Polysomnography; Postoperative Care; Preoperative Care; Retrospective Studies; Rhinitis; Severity of Illness Index; Sinusitis; Sleep Apnea, Obstructive; Treatment Outcome

Topics: Endoscopy; Female; Humans; Male; Middle Aged; Nose; Pilot Projects; Sleep Apnea, Obstructive; Snoring; Treatment Outcome

Complex sleep apnea syndrome (CompSAS) is characterized by predominant obstructive sleep disordered breathing with evolution of central disordered breathing following exposure to nasal continuous positive airway pressure (CPAP) therapy in obstructive sleep apnea (OSA) patients. We report a case of CompSAS associated with use of a nasal expiratory positive airway (nEPAP, Provent) device. We therefore recommend obtaining objective sleep data to confirm treatment effectiveness of the nEPAP device for OSA prior to long-term prescription. Further research is warranted to understand the underlying pathophysiological mechanisms and risk factors associated with CompSAS.

Topics: Aged; Humans; Male; Nose; Polysomnography; Positive-Pressure Respiration; Sleep Apnea, Obstructive

Obstructive sleep disordered breathing can cause death and significant morbidity in adults and children. We previously found that children with smaller upper airways (measured by magnetic resonance imaging while awake) generated loud high frequency inspiratory sounds (HFIS, defined as inspiratory sounds > 2 kHz) while they slept. The purpose of this study was (1) to determine what characteristics of airflow predicted HFIS intensity, and (b) to determine if we could calculate changes in hydraulic diameter (D) in both an in vitro model and in the upper airways of sleeping humans. In an in vitro model, high frequency sound intensity was an estimate of airflow turbulence as reflected by the Reynold's number (Re). D of the in vitro model was calculated using Re, the pressure gradient, Swamee-Jain formula and Darcy formula. D was proportional to but smaller than the actual diameters (r(2) = 0.94). In humans, we measured HFIS intensity and the pressure gradient across the upper airway (estimated with oesophageal pressure, Pes) during polysomnography in four adult volunteers and applied the same formulae to calculate D. At apnoea termination when the airway opens, we observed (1) an increase in HFIS intensity suggesting an increase in turbulence (higher Re), and (2) a larger calculated D. This method allows dynamic estimation of changes in relative upper airway hydraulic diameter (D) in sleeping humans with narrowed upper airways.

Topics: Adult; Humans; Inhalation; Larynx; Models, Biological; Nose; Sleep Apnea, Obstructive; Snoring

Topics: Costs and Cost Analysis; Female; Humans; Male; Nose; Pressure; Sleep Apnea, Obstructive

The few studies that examine the effect of nasal abnormalities on continuous positive airway pressure device (CPAP) adherence are controversial. The aim of this study was to evaluate the contribution of nasal abnormalities in CPAP adherence.. We included patients with moderate to severe OSA. The patients were submitted to rhinoscopy, nasofibroscopy, nasal inspiratory peak flow, and acoustic rhinometry. The patients who used a CPAP for 4 h or more per night for at least 70 % of the nights over a 6-month period were considered to have good adherence.. Thirty-four patients finished the study. Eleven (33.4 %) were female and 23 (67.6 %) were male. Sixteen (47.1 %) patients had good adherence. The body mass index (p = 0.030), neck circumference (p = 0.006), and apnea-hypopnea index (p = 0.032) were higher, and the oxyhemoglobin saturation minimum was lower (p = 0.041) in the good adherence group. Nasal parameters showed no differences between good and poor adherence groups. In Spearman's correlation, surprisingly, there was a negative correlation between the highest number of hours of CPAP use with smaller values of nasal minimal cross-sectional areas in the supine position (r, 0.375; p = 0.029). In the linear regression model, the nasal findings that predicted increased of the CPAP use were the following: lower scores of nasal symptoms (p = 0.007) and lower nasal volume in supine position (p = 0.001).. The majority of the nasal parameters evaluated in this study did not influence CPAP adherence.

Topics: Adult; Aged; Airway Resistance; Continuous Positive Airway Pressure; Endoscopy; Female; Humans; Male; Middle Aged; Nasal Obstruction; Nose; Patient Compliance; Polysomnography; Rhinometry, Acoustic; Sleep Apnea, Obstructive

The diagnosis of obstructive sleep apnea (OSA) relies on polysomnography (PSG), a multidimensional biosignal recording that is conducted in sleep laboratories. Standard PSG montage involves the use of nasal-oral airflow sensors to visualize cyclic episodes of upper airflow interruption, which are considered diagnostic of sleep apnea. Given the high-cost and discomfort associated with in-laboratory PSG, there is an emergent need for novel technology that simplifies OSA screening and diagnosis with less expensive methods. The main goal of this project was to identify novel OSA signatures based on the spectral analysis of thoraco-abdominal motion channels. Our main hypothesis was that proper spectral analysis can detect OSA cycles in adults using simultaneous recording of oxygen saturation (SaO2) and either, chest or abdominal motion. A sample study on 35 individuals was conducted with statistically significant results that suggest a strong relationship between airflow-independent signals and oxygen saturation. The impact of this new approach is that it may allow the design of more comfortable and reliable portable devices for screening, diagnosis and monitoring of OSA, functioning only with oximetry and airflow-independent (abdominal or chest) breathing sensors.

Topics: Abdomen; Adult; Female; Humans; Male; Monitoring, Physiologic; Motion; Multivariate Analysis; Nose; Oximetry; Oxygen; Polysomnography; Respiration; Signal Processing, Computer-Assisted; Sleep; Sleep Apnea, Obstructive; Thorax

Obstructive sleep apnea (OSA) is a prevalent disorder. The accepted method of diagnosis in widespread clinical practice, polysomnography (PSG), is costly and very time consuming; therefore, quick screening methods, especially when there is a need for quick diagnosis, is of great interest. Diagnostic methods which exploit subtle differences in breath sounds recorded during wakefulness, such as our group's Awake-OSA technology, have shown their capability to diagnose OSA at the research stage. Simplifying the breath sound recording procedure employed in the Awake-OSA diagnostic method would increase its efficiency when used in a clinical setting. In this study, we adopted breath sound data collected during wakefulness in two positions (sitting upright and supine) and two breathing maneuvers (nose and mouth breathing) from our previous study, and ran hypothesis tests on a wide variety of sound features to select the most significant features correlated with OSA. The goal was to investigate which combinations of patient position and breathing maneuver contribute the least to the significant features amongst groups of people with differing OSA severity, thus permitting simplification of the recording protocol. The results show that all signals recorded by a combination of the two breathing maneuvers and two positions result in features significantly correlated with OSA severity; this makes it impossible to confidently recommend that a combination be omitted from the recording protocol. Nevertheless, the results show that the majority of significant features originated from recordings made in the supine position. Therefore, as a step toward simplification of the Awake-OSA diagnostic algorithm, we may use breath sound signals recorded only in the supine position and further investigate the accuracy of the algorithm in distinguishing amongst groups with differing OSA severity.

Topics: Algorithms; Humans; Models, Biological; Nose; Polysomnography; Posture; Prospective Studies; Respiration; Respiratory Sounds; Sleep Apnea, Obstructive; Trachea; Wakefulness

OSAHS is a common disease with many factors related to the etiology. Airflow plays an important role in the pathogenesis of OSAHS. Previous research has not yielded a sufficient understanding of the relationship between airflow in upper airway and the pathophysiology of OSAHS. Therefore, a better understanding of the flow inside the upper airway in an OSAHS patient is necessary. In this study, ten Chinese adults with OSAHS were recruited. We used the software MIMICS 13.1 to construct 3-dimensional (3-D) models based on the computer tomography scans of them. The numerical simulations were carried out using the software ANSYS 12.0. We found that during the inhalation phase, the vortices and turbulences were located in both the anterior part of the cavity and nasopharynx. But there is no vortex in the whole nasal cavity during the expiratory phase. The airflow velocity is much higher than that of the normal models. The distributions of pressure and wall shear stress are different in two phases. The maximum velocity, pressure and wall shear stress (WSS) are located in velopharynx. It is notable that a strong negative pressure region is found in pharyngeal airway. The maximum velocity is 19.26 ± 12.4 and 19.46 ± 13.1 m/s; the average pressure drop is 222.71 ± 208.84 and 238.5 ± 218.56 Pa and the maximum average WSS is 0.72 ± 0.58 and 1.01 ± 0.61 Pa in inspiratory and expiratory, respectively. The changes of airflow due to the structure changes play an important role in the occurrence of collapse and obstruction of the upper airway, especially, the abnormal pressure changes in velopharyngeal during both inspiratory and expiratory phases. We can say that the airway narrowing in the pharynx may be one of the most important factors driving airway collapse. In addition, the most collapsible region of the pharyngeal airway of the patient with OSAHS may be the velopharynx and oropharynx. In spite of limitations, our results can provide a basis for the further research. On this basis, more about the secret of the pathogenesis of the OSAHS will be revealed.

Topics: Adult; Asian People; Computer Simulation; Female; Humans; Hydrodynamics; Imaging, Three-Dimensional; Male; Models, Biological; Nose; Pharynx; Respiratory Mechanics; Sleep Apnea, Obstructive; Software; Tomography, X-Ray Computed; Young Adult

Nasal obstruction frequently has been associated with obstructive sleep apnea (OSA). Although correction of an obstructed nasal airway is considered an important component in OSA treatment, the effect of nasal surgery on OSA remains controversial. Variation in airway anatomy between before and after nasal surgery may cause significant differences in airflow patterns within the upper airway. In this paper, anatomically accurate models of the interaction between upper airway and soft palate were developed from prenasal and post-nasal surgery multidetector computed tomography data of a patient with OSA and nasal obstruction. Computational modeling for inspiration and expiration was performed by using fluid-structure interaction method. The airflow characteristics such as velocity, turbulence intensity and pressure drop, and displacement distribution of soft palate are selected for comparison. Airway resistances significantly decrease after the nasal surgery, especially in the velopharynx region because of an enlarged pharyngeal cavity and a reduced upstream resistance. Meanwhile, the decreased aerodynamic force would result in a smaller displacement of soft palates, which would lead to slight impact of the soft palate motion on the airflow characteristics. The present results suggest that airflow distribution in the whole upper airway and soft palate motions have improved following nasal surgery.

Topics: Biomechanical Phenomena; Computer Simulation; Humans; Models, Biological; Nose; Pulmonary Ventilation; Sleep Apnea, Obstructive; Tomography, X-Ray Computed

The present study investigated whether cephalometric measurements can predict the therapeutic efficacy of multilevel phase I surgery for patients with obstructive sleep apnea (OSA).. Among 210 patients with OSA who underwent multilevel phase I surgery, 85 were recruited on the basis of the baseline polysomnography, body mass index, and lateral cephalogram recordings. The patients were divided into 2 groups according to the degree of change in the apnea-hypopnea index before and 6 months after multilevel surgery: good responders (>50% decrease in apnea-hypopnea index) and poor responders (0% to 50% decrease or increase in apnea-hypopnea index). Cephalometric analysis was performed to identify the relevant variables, with division into 5 compartments: craniofacial, soft palate, tongue, hyoid bone, and upper airway variables.. In the craniofacial compartment, poor responders represented skeletal Class II with a more retrognathic mandible, and a hyperdivergent vertical pattern with a larger mandibular plane angle, longer lower facial height, and steeper occlusal plane than good responders. In the upper airway compartment, poor responders had narrower middle and inferior airway spaces and a longer upper airway length than good responders. No significant differences were found in the soft palate, tongue, and hyoid measurements between the 2 groups.. Some preoperative cephalometric measurements were verified retrospectively to predict the therapeutic response to the multilevel surgery in patients with OSA. This study would contribute not only to establishing selective criteria for the surgical approach to patients with OSA in ear-nose-throat practice but also in deciding on the referral to orthodontists or maxillofacial surgeons.

Topics: Adult; Airway Obstruction; Body Mass Index; Cephalometry; Facial Bones; Humans; Hyoid Bone; Malocclusion, Angle Class II; Mandible; Middle Aged; Nose; Palate, Hard; Palate, Soft; Patient Selection; Pharynx; Polysomnography; Predictive Value of Tests; Regression Analysis; Retrognathia; Retrospective Studies; Sleep Apnea, Obstructive; Tongue; Treatment Outcome; Vertical Dimension

To determine whether surgery influences cardiovascular autonomic modulation in obstructive sleep apnoea syndrome (OSAS), the present study was performed to evaluate the effect of upper airway (UA) surgery on heart rate variability (HRV) using frequency domain analysis for patient groups who have had either successful or unsuccessful surgery. We compared body mass index (BMI), polysomnographic [apnoea index (AI), apnoea-hypopnoea index (AHI), minimum SaO(2)] and HRV [very low frequency (VLF) power, low frequency (LF) power, high frequency (HF) power, HF/LF ratio, LFnu = LF/(LF + HF), HFnu = HF/(LF + HF)] parameters between the unsuccessful (n = 14) and successful (n = 22) surgical groups before and after UA surgery. Significant changes were observed for the successful patient group with respect to mean AI (from 29.1 ± 21.3 to 2.0 ± 3.2 events h(-1), P < 0.001), AHI (from 38.6 ± 20.0 to 5.6 ± 5.1 events h(-1), P < 0.001), minimum SaO(2) (from 73.3 ± 12.7 to 86.3 ± 6.5%, P < 0.001), VLF power (from 25599 ± 12906 to 20014 ± 9839 ms(2), P = 0.013), LF power (from 17293 ± 7278 to 14155 ± 4980 ms(2), P = 0.016), LFnu (from 0.700 ± 0.104 to 0.646 ± 0.128, P = 0.031) and HFnu (from 0.300 ± 0.104 to 0.354 ± 0.128, P = 0.031); however, mean BMI, HF power and LF/HF ratio did not change significantly after UA surgery. No significant changes were observed in the unsuccessful surgical group. Successful UA surgery may improve cardiac sympathetic and parasympathetic modulation in patients with OSAS.

Topics: Adult; Body Mass Index; Female; Heart Rate; Humans; Male; Nose; Pharynx; Polysomnography; Severity of Illness Index; Sleep Apnea, Obstructive; Treatment Outcome

To propose an algorithm for the preoperative management of patients with obstructive sleep apnea syndrome (OSAS) and review the surgical outcomes in such patients.. This prospective cohort study involved 71 patients with OSAS who underwent presurgical upper airway endoscopy and cephalometry before being assigned to treatment categories based on the site(s) of obstruction, the pattern of collapse, the characteristics of the soft tissue, the air space between the base of the tongue and the posterior wall of the pharynx, and the severity of OSAS. Six months after surgery, they were followed up using polysomnography and the Epworth Sleepiness Scale. The pre- and postsurgical data were compared using a paired Student t test.. The mean preoperative apnea/hypopnea index of the 71 patients (61 male and 10 female) was 40.98 events/hour (range, 14.7 to 87.6 events/hr), and the mean postoperative apnea/hypopnea index was 13.96 events/hour (range, 0 to 20 events/hr). The difference was statistically significant (P < .001).. This algorithm was developed on the principle that every patient with OSAS should be considered individually. In the authors' opinion, taking into account the number, site(s), pattern, and degree of the collapse/obstruction is a reasonable means of ensuring the correct diagnosis and treatment.

Topics: Adult; Aged; Airway Obstruction; Algorithms; Cephalometry; Cohort Studies; Endoscopy; Female; Follow-Up Studies; Humans; Hypopharynx; Male; Middle Aged; Nasal Obstruction; Nose; Oropharynx; Orthognathic Surgical Procedures; Patient Care Planning; Pharyngeal Diseases; Polysomnography; Preoperative Care; Prospective Studies; Sleep Apnea, Obstructive; Sleep Stages; Tongue; Treatment Outcome

The main pathological event of obstructive sleep apnea hypopnea syndrome (OSAHS) is the apneic collapse of the upper airways (UA). Frequently, UA collapse occurs at the same time at different section levels. Identifying the site and the dynamic pattern of obstruction is mandatory in therapeutical decision-making, and in particular if a surgical therapy option is taken into account. Nowadays, awake fiberoptic nasopharyngeal endoscopy represents the first level diagnostic technique to be performed in such patients, but recently, the drug-induced sleep endoscopy (DISE) has been introduced to overcome the limits of the awake nasopharyngeal endoscopy. Whatever diagnostic tool we decide to use, one of the main problems encountered is the standardization of the description of the sites and dynamic patterns of UA collapses. In this paper, the authors describe the NOHL classification, which could be applied during awake and sleep endoscopy, and allows a simple, quick, and effective evaluation of grade and patterns of UA collapse, suggesting its application, especially in therapeutical decision-making and in the analysis of surgical outcomes.

Topics: Adult; Diagnosis, Differential; Endoscopy; Humans; Hypopharynx; Larynx; Middle Aged; Nose; Oropharynx; Polysomnography; Reproducibility of Results; Sleep Apnea, Obstructive

To examine the impact of using a nasal pressure sensor only vs the American Academy of Sleep Medicine (AASM) recommended combination of thermal and nasal pressure sensors on (1) the apnea index (AI), (2) the apnea-hypopnea index (AHI), where the AHI is calculated using both AASM definitions of hypopnea, and (3) the accuracy of a diagnosis of obstructive sleep apnea (OSA).. Retrospective review of previously scored in-laboratory polysomnography.. A tertiary-hospital clinical sleep laboratory.. One hundred sixty-four consecutive adult patients with a potential diagnosis of OSA, who were examined during a 3-month period.. N/A.. Studies were scored with and without the use of the oronasal thermal sensor. AIs and AHIs, using the nasal pressure sensor alone (AI(np) and AHI(np)), were compared with those using both a thermal sensor for the detection of apnea and a nasal pressure transducer for the detection of hypopnea (AI(th) and AHI(th)). Comparisons were repeated using the AASM recommended (AASM(rec)) and alternative (AASM(alt)) hypopnea definitions. AI was significantly different when measured from the different sensors, with AI(np) being 51% higher on average. Using the AASM(rec) hypopnea definition, the mean AHI(np) was 15% larger than the AHI(th); with large interindividual differences and an estimated 9.8% of patients having a false-positive OSA diagnosis at a cutpoint of 15 events and 4.3% at 30 events per hour. Using AASM(alt) hypopnea definition, the mean AHI(np) was 3% larger than the AHI(th), with estimated false-positive rates of 4.6% and 2.4%, respectively. The false-negative rate was negligible at 0.1% for both hypopnea definitions.. This study demonstrates that using only a nasal pressure sensor for the detection of apnea resulted in higher values of AI and AHI than when the AASM recommended thermal sensor was added to detect apnea. When the AASM(alt) hypopnea definition was used, the differences in AHI and subsequent OSA diagnosis were small and less than when the AASM(rec) hypopnea definition was used. In situations in which a thermal sensor cannot be used, for example, in limited-channel diagnostic devices, the AHI obtained with a nasal pressure sensor alone differs less from the AHI obtained from a polysomnogram that includes a thermal sensor when the AASM(alt) definition rather than the AASM(rec) definition of hypopnea is used. Thus, diagnostic accuracy is impacted both by the absence of the thermal sensor and by the rules used to analyze the polysomnography. Furthermore, where the thermal sensor is unreliable for sections of a study, it is likely that use of the nasal pressure signal to detect apnea will have modest impact.

Topics: Adult; Female; Humans; Male; Middle Aged; Nose; Polysomnography; Practice Guidelines as Topic; Predictive Value of Tests; Retrospective Studies; Sleep Apnea, Obstructive; Societies, Medical; South Australia; Transducers, Pressure; United States

This is an investigation of anatomical and sleep history risk factors that were associated with abrupt sleep-associated death in seven children with good pre-mortem history. Seven young children with abrupt deaths and information on health status, sleep history, death scene report, and autopsy performed in a specialized unit dedicated to investigation of abrupt death in young children were investigated Seven age and gender matched living children with obstructive-sleep-apnea (OSA) were compared to the findings obtained from the dead children. Two deaths results from accidents determined by the death scene and five were unexplained at the death scene. History revealed presence of chronic indicators of abnormal sleep in all cases prior death and history of an acute, often mild, rhinitis just preceding death in several. Four children, including three infants, were usually sleeping in a prone position. Autopsy demonstrated variable enlargement of upper airway soft tissues in all cases, and in all cases, there were features consistent with a narrow, small nasomaxillary complex, with or without mandibular retroposition. All children were concluded to have died of hypoxia during sleep. Our OSA children presented similar complaints and similar facial features. Anatomic risk factors for a narrow upper airway can be determined early in life, and these traits are often familial. Their presence should lead to greater attention to sleep-related complaints that may be present very early in life and indicate impairment of well been and presence of sleep disruption. Further investigation should be performed to understand the role of upper airway infection in the setting of anatomically small airway in apparently abrupt death of infants and toddlers.

Topics: Child, Preschool; Death, Sudden; Female; Humans; Hypoxia; Infant; Male; Maxilla; Nose; Palate, Hard; Retrospective Studies; Risk Factors; Sleep Apnea, Obstructive

Topics: Airway Resistance; Continuous Positive Airway Pressure; Female; Humans; Male; Nose; Polysomnography; Prostheses and Implants; Sensitivity and Specificity; Sleep Apnea, Obstructive

In view of the high prevalence and the relevant impairment of patients with obstructive sleep apnoea syndrome (OSAS) lots of methods are offered which promise definitive cures for or relevant improvement of OSAS. This report summarises the efficacy of alternative treatment options in OSAS. An interdisciplinary European Respiratory Society task force evaluated the scientific literature according to the standards of evidence-based medicine. Evidence supports the use of mandibular advancement devices in mild to moderate OSAS. Maxillomandibular osteotomy seems to be as efficient as continuous positive airway pressure (CPAP) in patients who refuse conservative treatment. Distraction osteogenesis is usefully applied in congenital micrognathia or midface hypoplasia. There is a trend towards improvment after weight reduction. Positional therapy is clearly inferior to CPAP and long-term compliance is poor. Drugs, nasal dilators and apnoea triggered muscle stimulation cannot be recommended as effective treatments of OSAS at the moment. Nasal surgery, radiofrequency tonsil reduction, tongue base surgery, uvulopalatal flap, laser midline glossectomy, tongue suspension and genioglossus advancement cannot be recommended as single interventions. Uvulopalatopharyngoplasty, pillar implants and hyoid suspension should only be considered in selected patients and potential benefits should be weighed against the risk of long-term side-effects. Multilevel surgery is only a salvage procedure for OSA patients.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Continuous Positive Airway Pressure; Female; Humans; Hyoid Bone; Male; Mandibular Advancement; Middle Aged; Nose; Osteogenesis, Distraction; Palate; Pharynx; Salvage Therapy; Severity of Illness Index; Sleep Apnea, Obstructive; Tongue; Young Adult

Topics: Cephalometry; Dental Arch; Female; Humans; Male; Malocclusion, Angle Class II; Mandible; Maxilla; Nose; Pharynx; Sex Factors; Sleep Apnea, Obstructive

To investigate the effect and clinical value of simultaneous multiple plane operations in treating severe OSAHS.. The clinical data of 93 patients with severe OSAHS were retrospectively analyzed. According to different obstruction plane, all the patients were performed different multiple planes of operations. Operations were finished in the same term. All patients underwent PSG examination before operation and 6-month, 1 year after surgical treatment separately.. No severe complication occurred. According to the assessment guidelines, the response rate was 100% in 6-month and 91.40% in 1-year respectively.. Most OSAHS have multi-level obstructions in upper airway caliber, such as nasal, nasopharyngeal, velo-pharyngeal and tongue-pharyngeal obstruction. Simultaneous multiple plane operations which based on multiple plane obstruction can improve curative effect.

Topics: Adult; Apnea; Female; Humans; Male; Middle Aged; Nasopharynx; Nose; Otorhinolaryngologic Surgical Procedures; Pharynx; Polysomnography; Retrospective Studies; Sleep Apnea, Obstructive; Tongue

The aim of the present study is to investigate nasal airway morphology in Asian adults with and without obstructive sleep apnea (OSA) using acoustic rhinometry (AR), principal components analysis (PCA), and 3-D finite-element analysis (FEA). One hundred eight adult Malays aged 18-65 years (mean ± SD, 33.2 ± 13.31) underwent clinical examination and limited channel polysomnography, providing 54 patients with OSA and 54 non-OSA controls. The mean minimal cross section area 1 (MCA1) and the mean minimal cross sectional area 2 (MCA2) were obtained from AR for all subjects and subjected to t tests. The OSA and control nasal airways were reconstructed in 3-D and subjected to PCA and FEA. The mean MCA1 and MCA2 using AR were found to be significantly smaller in the OSA group than in the control group (p < 0.001). Comparing the 3-D OSA and control nasal airways using PCA, the first two eigenvalues accounted for 94% of the total shape change, and statistical differences were found (p < 0.05). Similarly, comparing the nasal airways using FEA, the 3-D mean OSA nasal airway was significantly narrower in the OSA group compared to the control group. Specifically, decreases in size of approx. 10-22% were found in the nasal valve/head of inferior turbinate area. In conclusion, differences in nasal airway morphology are present when comparing patients with OSA to controls. These differences need to be recognized as they can improve our understanding of the etiological basis of obstructive sleep apnea and facilitate its subsequent management.

Topics: Adolescent; Adult; Aged; Anatomy, Cross-Sectional; Asia, Southeastern; Body Mass Index; Cross-Sectional Studies; Female; Finite Element Analysis; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Male; Middle Aged; Nasal Cavity; Nose; Polysomnography; Principal Component Analysis; Rhinometry, Acoustic; Sleep Apnea, Obstructive; Turbinates; Young Adult

Obstructive sleep apnea (OSA) is a disorder that is associated with increased morbidity and mortality. Although continuous positive airway pressure effectively treats OSA, compliance is variable because of the encumbrance of wearing a sealed nasal mask throughout sleep. In a small group of patients, it was recently shown that an open nasal cannula (transnasal insufflation [TNI]) can treat OSA. The aim of this larger study was to find predictors for treatment responses with TNI.. Standard sleep studies with and without TNI were performed in 56 patients with a wide spectrum of disease severity. A therapeutic response was defined as a reduction of the respiratory disturbance index (RDI) below 10 events/h associated with a 50% reduction of the event rate from baseline and was used to identify subgroups of patients particularly responsive or resistant to TNI treatment.. For the entire group (N = 56), TNI decreased the RDI from 22.6 +/- 15.6 to 17.2 +/- 13.2 events/h (P < .01). A therapeutic reduction in the RDI was observed in 27% of patients. Treatment responses were similar in patients with a low and a high RDI, but were greater in patients who predominantly had obstructive hypopneas or respiratory effort-related arousals and in patients who predominantly had rapid eye movement (REM) events. The presence of a high percentage of obstructive and central apneas appears to preclude efficacious treatment responses.. TNI can be used to treat a subgroup of patients across a spectrum from mild-to-severe sleep apnea, particularly if their sleep-disordered breathing events predominantly consist of obstructive hypopneas or REM-related events but not obstructive and central apneas.

Topics: Catheterization; Equipment Design; Female; Follow-Up Studies; Humans; Insufflation; Male; Middle Aged; Nose; Polysomnography; Retrospective Studies; Sleep Apnea, Obstructive; Treatment Outcome

To study the effect of OSAHS on adult nasal-cycle.. The nasal cycle of 20 healthy adults, 18 patients of snoring and 22 patients of OSAHS were examined with acoustic rhinometry, which was performed every 30 minutes in 7 hours.. The ratio of nasal cycle in healthy adults was (19/20, 95.0%), in snoring patients was (15/18, 83.0%), in patients of OSAHS was (15/22, 68.2%). The mean alteration amplitude of nasal cycle in healthy adults was significantly larger than that in patients with OSAHS (P < 0.05). The distribution of the healthy adults and patients with OSAHS between the typical cycle categories was significantly different (P < 0.05).. The characteristics of nasal-cycle in of OSAHS patients were different with healthy adults, which maybe owing to change of physical function of basal cavity.

Topics: Adult; Aged; Case-Control Studies; Female; Humans; Male; Middle Aged; Nasal Cavity; Nose; Rhinometry, Acoustic; Sleep Apnea, Obstructive; Snoring

This study evaluates the effectiveness of maxillo-mandibular advancement (MMA) in patients with obstructive sleep apnea syndrome (OSAS), even those without skeletal anomalies, indicating the possibility of extending this procedure to more patients. Two groups with different skeletal patterns were studied pre- and post-surgery. Group 1 (11 patients) had severe or moderate OSAS and maxillo-mandibular hypoplasia and/or mandibular deformities (SNA angle 78 degrees or less or SNA angle>78 degrees but with SNB<65 degrees and severe skeletal class II malocclusion). Group 2 (11 patients) had severe or moderate OSAS without maxillo-mandibular hypoplasia or deformity (SNA angle>80 degrees , dental class I occlusion). Analysis comprised: apnea hypopnea index (AHI), posterior airway space (PAS), SNA and SNB angles, Epworth sleepiness scale (ESS), body mass index (BMI), and a subjective standardized questionnaire about aesthetic appearance. All patients had increased PAS width and complete remission of objective and subjective OSAS symptoms evaluated by AHI and ESS. Results in both groups are comparable. Data were analysed using t-test; p<0.005 was statistically significant. All patients were satisfied with the functional and aesthetic results. MMA is effective in patients with severe or moderate OSAS, even in those without skeletal and/or occlusal anomalies and can be considered in more patients.

Topics: Adult; Cephalometry; Chin; Female; Humans; Jaw Fixation Techniques; Male; Malocclusion, Angle Class II; Mandibular Advancement; Maxilla; Micrognathism; Middle Aged; Nose; Patient Satisfaction; Pharynx; Radiography; Retrospective Studies; Sleep Apnea, Obstructive; Surveys and Questionnaires; Treatment Outcome

Polysomnographic signals are usually recorded from patients exhibiting symptoms related to sleep disorders such as obstructive sleep apnea (OSA). Analysis of polysomnographic data allows for the determination of the type and severity of sleep apnea or other sleep-related disorders by a specialist or technician. The usual procedure entails an overnight recording several hours long. This paper presents a methodology to help with the screening of OSA using a 5-min oronasal airway pressure signal emanating from a polysomnographic recording during the awake period, eschewing the need for an overnight recording. The clinical sample consisted of a total of 41 subjects, 20 non-OSA individuals and 21 individuals with OSA. A signal analysis technique based on the Hilbert-Huang transform was used to extract intrinsic oscillatory modes from the signals. The frequency distribution of both the first mode and second mode and their sum were shown to differ significantly between non-OSA subjects and OSA patients. An index measure based on the distribution frequencies of the oscillatory modes yielded a sensitivity of 81.0% (for 95% specificity) for the detection of OSA. Two other index measures based on the relation between the area and the maximum of the 1st and 2nd halves of the frequency histogram both yielded a sensitivity of 76.2% (for 95% specificity). Although further tests will be needed to test the reproducibility of these results, the proposed measures seem to provide a fast method to screen OSA patients, thus reducing the costs and the waiting time for diagnosis.

Topics: Adult; Female; Humans; Male; Middle Aged; Mouth; Nose; Polysomnography; Pressure; ROC Curve; Sleep Apnea, Obstructive; Wakefulness

The purpose of the prominent human external nose remains unclear. The external nose may play a compensatory role in the aerodynamic support of the upper airway, which in humans has been severely narrowed to enable spoken language. During times of decreased muscle tone, the wing-like soft palate may be supported by airflow patterns, creating "lift." Serving as an aiming nozzle, the external nose may, by creating a curvilinear intranasal airflow pattern, adjust the "angle of attack" of airflow contacting the palate, thus enhancing lift and facilitating opening of the nasopharynx. This concept was tested, comparing nasopharyngeal opening and wind speed in curvilinear and linear nonanatomic models. Statistically significant differences were found, with enhanced opening in the curvilinear model. Related findings in hominid nasal bone fossil analysis show that the external nose developed contemporaneous to the development of language. These findings may have clinical implications in the management of obstructive sleep apnea.

Topics: Continuous Positive Airway Pressure; Humans; Nasal Obstruction; Nose; Palate, Soft; Pharynx; Sleep Apnea, Obstructive

Obstructive sleep apnea syndrome (OSAS) is commonly associated with adenotonsillar hypertrophy. We hypothesized that respiratory perturbations extend to other regions of the upper respiratory tract in such children, particularly to rhino-sinus regions.. A prospective case control study using Magnetic Resonance Imaging (MRI) of the upper airway and surrounding tissues of OSAS and controls. Magnetic resonance imaging was used to evaluate radiographic changes within the: paranasal sinuses, middle ear and mastoid air cells, and the nasal passages.. We studied 54 OSAS (age 5.7 ± 3.0 years) and 54 controls (age 6.2 ± 2.0 years, P = NS). Children with OSAS had significantly more opacification of: maxillary sinuses (P < 0.05), sphenoid sinuses (P < 0.01), and mastoid air cells (P < 0.01). They also had significantly more: middle ear effusions, (P < 0.001), prominence of inferior nasal turbinate(s) (P < 0.05), and deviation of the nasal septum (P < 0.05).. Childhood OSAS is associated with a wide range of upper respiratory tract perturbations and is not limited to adenoid and tonsillar hypertrophy.

Topics: Case-Control Studies; Child; Child, Preschool; Ear, Middle; Female; Humans; Magnetic Resonance Imaging; Male; Nose; Paranasal Sinuses; Sleep Apnea, Obstructive

Topics: Humans; Nasal Obstruction; Nose; Polysomnography; Sleep Apnea, Obstructive

Topics: Child; Ear, Middle; Humans; Inflammation; Magnetic Resonance Imaging; Mastoid; Nose; Sleep Apnea, Obstructive

Topics: Aged; Continuous Positive Airway Pressure; Eyelid Diseases; Humans; Male; Nose; Sleep Apnea, Obstructive; Subcutaneous Emphysema

Topics: Adult; Airway Resistance; Continuous Positive Airway Pressure; Humans; Male; Nasal Obstruction; Nose; Sleep Apnea, Obstructive

Obstructive sleep apnea syndrome (OSAS) is characterized by repetitive episodes of partial or complete obstruction of the upper airway during sleep and is associated with increasing respiratory efforts, with a consequent oxyhemoglobin desaturation, sleep fragmentation, and daytime symptoms, most commonly excessive sleepiness. The effectiveness of continuous positive airway pressure (CPAP) is undoubtedly high in treating those patients who use it regularly, but for those who refuse it, the success rate is 0. It is for this subset of patients that surgical therapy can be useful. The purpose of this study was to evaluate the effects of nasal surgery on nasal resistance, sleep apnea, sleep quality, and nasal volumetric measurement in adult male patients with OSAS.. Twenty male patients with complaints of hypersomnia and snoring were included in the study. Polysomnography of patients with the prediagnosis of OSAS was planned. All patients underwent CPAP treatment before and after surgery. Patients, who had anatomic structural defects causing nasal valve shrinkage, were operated on at the Plastic Reconstructive and Aesthetic Department. Volumetric measurements of the nose were obtained before and after the operation.. In our study, it was observed that respiratory tract space of patients increased subsequent to the surgery, and thereby OSAS level decreased, and tolerating CPAP device was easier. Measurements of internal nasal valve vertex and fields and external nasal valve fields before and after operation were significant.. Surgical relief of this nasal obstruction may improve quality of life in patients with OSAS.

Topics: Adult; Airway Resistance; Anatomy, Cross-Sectional; Cephalometry; Continuous Positive Airway Pressure; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Nasal Obstruction; Nose; Oxygen; Polysomnography; Pulmonary Ventilation; Quality of Life; Sleep; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Sleep Stages; Snoring; Time Factors; Treatment Outcome

Our objective was to investigate the occurrence of sleep-related breathing disturbances in a large cohort of school-aged children in Southern Italy, and to evaluate the association with anthropometric data and clinical findings of oropharynx and nasal airways.. A two-phase cross-sectional study was conducted with children from schools in Turi, Italy.. A screening phase aimed to identify symptomatic children and clinical data from a cohort of 495 children by a self-administered questionnaire, and an instrumental phase for the definition of sleep-related disorders and clinical analysis of oral status were performed. According to the answers, children were classified into 3 groups: habitual snorers, occasional snorers, and non-snorers. All habitual snoring children underwent a polysomnographic home evaluation, and those with oxygen desaturation index (ODI) > 2 were considered for nocturnal polygraphic monitoring (NPM). Children with apnoea/ hypopnea index (AHI) > 3 received a diagnosis of obstructive sleep apnoea syndrome (OSAS). Moreover, a complete oral examination was performed.. A total of 436 questionnaires (response rate: 88.08%) were returned and scored (202 M, 234 F; Mean age ± Standard deviation: 6.2 ± 1.8); 18 children (4%) were identified as habitual snorers, 140 children (32%) were identified as occasional snorers, and 278 children (64%) were identified as non-snorers. The percentage of female children who were habitual snorers was higher than the percentage of male children (4.7% vs 3.6%). Habitual snorers had significantly more nighttime symptoms. OSAS was diagnosed in 2 children by NPM. A statistically significant association between snoring, cross-bite, open-bite and increased over-jet was found.. Habitual snoring and OSAS are significant problems for children and may be associated with diurnal symptoms. The presence of malocclusion increases the likelihood of sleep-related breathing disturbances.

Topics: Airway Obstruction; Bronchitis; Child; Child, Preschool; Female; Humans; Italy; Male; Nose; Open Bite; Oropharynx; Otitis; Overbite; Prevalence; Sinusitis; Sleep Apnea, Obstructive; Snoring; Surveys and Questionnaires; Tonsillitis

The purposes of this study were to establish normative data for airway size and shape and to evaluate differences associated with age and sex using 3-dimensional (3-D) imaging. Patients being evaluated by computed tomography (CT) for pathologic conditions not related to the airway were included. Using 3-D Slicer (Harvard Surgical Planning Laboratory, Brigham and Women's Hospital, Boston, MA), a software program, digital 3-D CT reconstructions were made and parameters of airway size analyzed: volume (VOL), surface area (SA), length (L), mean cross-sectional area (mean CSA), minimum retropalatal (RP), minimum retroglossal (RG), minimum cross-sectional area (min CSA), and lateral (LAT) and anteroposterior (AP) retroglossal airway dimensions. Evaluation of airway shape included LAT/AP and RP/RG ratios, uniformity (U), and sphericity, a measure of compactness (Psi). Children were stratified by stage of dentition: primary, 0 to 5 years; mixed, 6 to 11 years; permanent, 12 to 16 years; and adults, older than 16 years. Differences in airway parameters by age and sex were analyzed. Forty-six CT scans (31 males) were evaluated. Adults had larger (VOL, SA, L, mean CSA, and LAT), more elliptical (increased LAT/AP, P = 0.01), less uniform (U, P = 0.02), and less compact (decreased Psi, P = 0.001) airways than children. Among children, those in the permanent dentition demonstrated greater VOL (P < 0.01), SA (P < 0.01), L (P < 0.01), and mean CSA (P < 0.01) than those in the primary dentition. There were no gender differences in airway parameters. Understanding differences in 3-D airway size and morphology by age may serve as a basis for evaluation of patients with obstructive sleep apnea and may help to predict and to evaluate outcomes of treatment.

Topics: Adolescent; Adult; Age Factors; Child; Child, Preschool; Female; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Infant; Infant, Newborn; Larynx; Male; Middle Aged; Nose; Pharynx; Reference Values; Retrospective Studies; Sex Factors; Sleep Apnea, Obstructive; Tomography, X-Ray Computed; Young Adult

Maxillomandibular advancement is one of the treatments available for obstructive sleep apnea. The influence of this surgery on the upper airway and its mechanism are not fully understood. The present research simulates the flow fields of narrowed upper airways of 2 patients with obstructive sleep apnea treated with maxillomandibular advancement. The geometry of the upper airway was reconstructed from computed tomographic images taken before and after surgery. The consequent three-dimensional surface model was rendered for measurement and computational fluid dynamics simulation. Patients showed clinical improvement 6 months after surgery. The cross-sectional area of the narrowest part of the upper airway was increased in all dimensions. The simulated results showed a less constricted upper airway, with less velocity change and a decreased pressure gradient across the whole conduit during passage of air. Less breathing effort is therefore expected to achieve equivalent ventilation with the postoperative airway. This study demonstrates the possibility of computational fluid dynamics in providing information for understanding the pathogenesis of OSA and the effects of its treatment.

Topics: Adult; Airway Resistance; Anatomy, Cross-Sectional; Computer Simulation; Dental Occlusion; Follow-Up Studies; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Larynx; Male; Mandibular Advancement; Maxilla; Models, Biological; Nasal Cavity; Nasopharynx; Nose; Pharynx; Pilot Projects; Polysomnography; Pressure; Pulmonary Ventilation; Respiration; Rheology; Sleep Apnea, Obstructive; Tomography, X-Ray Computed; Work of Breathing

Polysomnography (PSG) is the gold standard in diagnosing sleep disordered breathing (SDB). Diagnostic analysis of SDB is time-consuming and labor-intensive and entails long waiting lists for patients. The aim of this study was to assess the validity of a flow-based screening classifier as an automated diagnostic test for Cheyne-Stokes respiration (CSR).. Sleep laboratory.. 70 study subjects (28 with obstructive sleep apnea [OSA], 20 with CSR, 11 with CSR+OSA and 11 without SDB).. The nasal cannula flow signal was analyzed by ApneaLink (ResMed, Sydney, Australia), based on a classifier algorithm using pattern recognition. In a simultaneous PSG, results were compared with manual scoring of respiratory events by certified sleep experts.. For detecting CSR we obtained a sensitivity of 87.1% (95% confidence interval 75.3% to 98.9%), a specificity of 94.9% (95% confidence interval 87.9% to 100%), a positive likelihood ratio of 17.0, and a negative likelihood ratio of 0.14. The area under the curve (AUC) of the according receiver operating characteristic (ROC) curve was 93.4%. This resulted in an accuracy of 91.4% for identifying CSR.. In this study we demonstrated that the screening classifier was able to detect CSR with high diagnostic accuracy. Hence, ApneaLink equipped with CSR classifier is an appropriate screening tool which may help to prioritize patients with CSR for PSG.

Topics: Aged; Cheyne-Stokes Respiration; Comorbidity; Equipment Design; Female; Fourier Analysis; Humans; Male; Manometry; Mass Screening; Middle Aged; Neural Networks, Computer; Nose; Polysomnography; Pulmonary Ventilation; ROC Curve; Sensitivity and Specificity; Signal Processing, Computer-Assisted; Sleep Apnea, Obstructive; Transducers, Pressure

To study the role of adjunctive upper airway surgery in obese patients with obstructive sleep apnea (OSA) who were poorly compliant with continuous positive airway pressure (CPAP) therapy.. Retrospective study of obese patients with OSA and documented poor CPAP compliance who underwent noncurative upper airway surgery for anatomical obstruction. Data collected included polysomnogram (PSG) parameters, CPAP settings and compliance, and surgical complications.. An urban academic county hospital with an 8-bed sleep laboratory. Data were collected retrospectively from 2002 through 2005.. Subjects who met the following criteria: (1) documented OSA (apnea-hypopnea index [AHI] > or =5.0) treated with CPAP therapy, (2) poor CPAP compliance (<4 hours per night), (3) subjected to upper airway surgery, (4) repeated PSG after surgery revealed persistent OSA (AHI > or = 5) requiring continued treatment with CPAP, and (5) availability of presurgery and postsurgery CPAP compliance data.. Compliance with CPAP.. Data from 11 patients were available for analysis. Their PSG parameters revealed the mean AHI (79.0 before surgery vs 30.2 after surgery; P < .001) and mean CPAP pressure setting (11.8 cm H(2)O before surgery vs 10.4 cm H(2)O after surgery; P = .09) improved following surgery. A mean increase of 48.6 minutes in CPAP compliance was noted after surgery (P = .03). Eight of the 11 patients improved their CPAP compliance following surgical intervention, including 5 who improved by more than 1 hour.. Upper airway surgery in select patients with OSA may improve CPAP compliance and should be considered as a potential adjunctive therapeutic measure in poorly compliant patients with OSA.

Topics: Adult; Aged; Continuous Positive Airway Pressure; Female; Humans; Male; Middle Aged; Nose; Obesity; Oral Surgical Procedures; Patient Compliance; Pilot Projects; Polysomnography; Retrospective Studies; Sleep Apnea, Obstructive; Tonsillectomy; Treatment Outcome

To assess the accuracy of a single channel portable monitoring device (RUSleepingtrade mark RTS, Respironics, Murrysville, PA) that measures nasal pressure (a surrogate for airflow) to detect sleep disordered breathing (SDB). Twenty-five adult patients referred to a community sleep laboratory with suspected obstructive sleep apnea (OSA) participated in this investigation. The portable monitoring device was used in the sleep laboratory to acquire data concurrently with a standard multi-channel polysomnogram (PSG) to assess SDB. Respiratory events were scored manually on the PSG using standard criteria for clinical research to quantify an apnea-hypopnea index (AHI) based on events during sleep. The portable monitoring device automatically calculated an unedited respiratory event index (REI) based on recording time. These data were then compared using the Pearson product-moment correlation coefficient, Bland-Altman analysis, receiver operating characteristic (ROC) curves, and likelihood ratios. All 25 subjects completed the study. Mean age of subjects was 42.4 +/- 12.9 years and mean body mass index was 31.0 +/- 7.4 kg m(-2). There was good agreement between the REI and the AHI (R = 0.77, p < 0.001, mean difference 2.6 events per hour [2 SD: 39.8] using a Bland-Altman plot). The area under the ROC curve for detecting SDB (PSG AHI greater than or equal to five events per hour) with the REI was 0.94 (95% CI 0.84-1.0). For an REI >11.9 events per hour, the sensitivity was 0.89 (95% CI 0.65-0.99) and the specificity was 0.86 (95% CI 0.42-1.0) with a likelihood ratio of 6.2 for a positive test (LR+) and 0.13 for a negative test (LR-). Similar results were observed for detecting moderate-severe SDB (PSG AHI > or = 15 events h(-1)) using REI >15.2 events h(-1). In a population of subjects with suspected OSA, this portable monitoring device can automatically quantify an REI that compares well to the AHI scored manually on a concurrent PSG. Such a device may prove useful to assess SDB in high risk populations with self-administered testing in ambulatory settings such as the home.

Topics: Adult; Aged; Equipment Design; Female; Humans; Male; Manometry; Middle Aged; Monitoring, Ambulatory; Nose; Polysomnography; Pulmonary Ventilation; Sensitivity and Specificity; Signal Processing, Computer-Assisted; Sleep Apnea, Obstructive; Transducers, Pressure; Young Adult

To explore the role of acoustic rhinometry in the diagnosis of children with obstructive sleep apnea-hypopnea syndrome (OSAHS).. Thirty-six patients with OSAHS were measured with acoustic rhinometry before and 1 month after adenoidectomy. Twenty patients with adenoidectomy were measured before and after operation, the changes in volume recorded by acoustic rhinometry were compared with the adenoid volume obtained by the method of "drain off the water".. The volume of nasopharynx of adenoid removal patients was significantly bigger than that of before operation. The adenoid volume of 20 patients obtained by the method of "drain off the water" was bigger than the calculated changes in nasopharynx volume recorded by acoustic rhinometry, however, they were found to be significantly interrelated.. Acoustic rhinometry is a better method to calculate the size of adenoid in children with OSAHS and it could become a routine examination before adenoidectomy.

Topics: Adenoidectomy; Child; Child, Preschool; Female; Humans; Male; Nose; Rhinometry, Acoustic; Sleep Apnea, Obstructive

In mucopolysaccharidoses, upper airway obstruction has multiple causative factors and progressive respiratory disease may severely affect morbidity and mortality. In a cross-sectional study over 2 years we evaluated upper airway obstructive disease through overnight polysomnography, upper airway computed tomography and nasal endoscopy in 5 children and 6 adults with mucopolysaccharidoses of various types. Measurements of apnoea and apnoea-hypopnoea index, arousal index, and sleep efficiency were obtained through polysomnography. Retropalatal and retroglossal spaces were calculated through computed tomography, and the degree of adenoid hypertrophy was assessed through endoscopy. Apnoea index and apnoea-hypopnoea index were significantly higher in children than in adults with mucopolysaccharidoses (p = 0.03 and p = 0.03, respectively). Compared to healthy controls, retropalatal and retroglossal spaces were significantly smaller in children (p = 0.03 and p = 0.004, respectively) or adults with mucopolysaccharidoses (p = 0.004 and p = 0.004, respectively). All subjects had adenoid hypertrophy causing first-degree (36%) or second-degree (64%) obstruction at endoscopy. Overnight polysomnography, upper airway computed tomography and nasal endoscopy are useful tools for diagnosing obstructive sleep apnoea syndrome in mucopolysaccharidoses, and identifying the site and severity of airway obstruction.

Topics: Adenoids; Adolescent; Adult; Case-Control Studies; Child; Child, Preschool; Cross-Sectional Studies; Endoscopy; Female; Fiber Optic Technology; Humans; Hypertrophy; Lung Diseases, Obstructive; Male; Mucopolysaccharidoses; Nose; Patient Care Team; Polysomnography; Predictive Value of Tests; Severity of Illness Index; Sleep; Sleep Apnea, Obstructive; Tomography, X-Ray Computed; Wakefulness

The goal of this retrospective study was to evaluate the horizontal and vertical facial soft tissue changes occurring after maxillomandibular advancement (MMA) surgery to treat obstructive sleep apnea (OSA).. The study group comprised 31 consecutive adult patients with OSA who underwent MMA through Le Fort I osteotomy and bilateral sagittal split ramus osteotomies. Adjunctive maxillary procedures, consisting of piriformplasty, anterior nasal spine recontouring, alar base cinch, and V-Y closure of the upper lip, were used for all patients. A "best-fit" templating cephalometric technique was used to assess dentoskeletal movements and corresponding soft tissue changes.. Maxillary movements (measured at point A) averaged 8.77 +/- 2.34 mm horizontally and 2.20 +/- 2.42 mm vertically. Mandibular movements (measured at point B) averaged 11.16 +/- 2.56 mm horizontally and 2.25 +/- 3.02 mm vertically. The horizontal upper lip soft tissue-to-hard tissue ratios averaged >0.90:1 (SLS/A, 0.97:1; Ls/U1fac, 0.96:1; Stm(s)/ls, 0.86:1). Upper lip length (Sn-Ls) increased by a clinically insignificant amount (0.37 mm). The nasolabial complex rotated in a counterclockwise rotation, with the nasolabial angle decreasing (3.87 degrees) due primarily to forward movement of the upper lip. Horizontal lower lip and chin soft tissue-to-hard tissue ratios averaged >0.90:1 (Stm(i)/li, 0.90:1; Li/Ii, 0.89:1; Pg'/Pg, 0.92:1; Me'/Me, 0.91:1).. This study demonstrated that MMA in this selected group of OSA patients results in soft tissue movements producing a soft tissue-to-hard tissue ratio of about 0.90:1 for most anatomic sites of the upper lip, lower lip, and chin.

Topics: Adult; Cephalometry; Chin; Face; Female; Humans; Linear Models; Lip; Male; Mandibular Advancement; Middle Aged; Nose; Orthognathic Surgical Procedures; Osteotomy, Le Fort; Reference Values; Retrospective Studies; Sleep Apnea, Obstructive

To study the treatment of OSAHS with nasal diseases by nasal operation.. Ninety four cases of OSAHS with nasal diseases were analyzed. The patients were operated on nasal cavity to improve ventilation included Septectomy, CPS for inferior turbinate and FESS. The patients were examined by PSG at 2 months and 1 year after operation. All patients were followed up one year.. Among 94 cases, 19 cases had efficient result after nasal operation and had no recurrence one year after operation. The efficient rate was 20. 21% (19/94). These patients were mild degree and I type. The other 75 cases had invalid result.. The patients of OSAHS with nasal diseases, especially mild degree and I type one should be undertaken nasal operation.

Topics: Adult; Endoscopy; Female; Humans; Male; Middle Aged; Nasal Cavity; Nose; Nose Diseases; Retrospective Studies; Sleep Apnea, Obstructive; Treatment Outcome

The aim of the study was to identify craniofacial and pharyngeal anatomical factors directly related to obstructive sleep apnoea (OSA). The design and setting was a hospital-based, case-controlled study. Ninety-nine subjects (78 males and 21 females) with a confirmed diagnosis of OSA, who were referred to the Dental Hospital for construction of a mandibular advancement splint were recruited. A similar number of control subjects, matched for age and sex, were recruited after completing snoring and Epworth Sleepiness Scale questionnaires to exclude habitual snoring and daytime sleepiness. An upright cephalogram was obtained and skeletal and soft tissue landmarks were traced and digitized. In OSA subjects the anteroposterior skeletal measurements, including maxillary and mandibular length were reduced (P < 0.001). The intermaxillary space was found to be 3.1 mm shorter in OSA subjects (P = 0.001). The nasopharyngeal airway in OSA subjects was narrower (P < 0.001) but pharyngeal length showed no difference. The tongue size was increased (P = 0.021), soft plate length, thickness and area were all greater (P < 0.001) and the hyoid bone was more inferiorly positioned in OSA subjects (P < 0.001). This study identifies a significant number of craniofacial and pharyngeal anatomical factors directly related to OSA.

Topics: Adult; Case-Control Studies; Cephalometry; Female; Humans; Hyoid Bone; Male; Middle Aged; Nose; Oropharynx; Palate, Soft; Pharynx; Skull Base; Sleep Apnea, Obstructive; Snoring; Tongue

Nasal septum surgery is frequently performed to establish a functional nasal airway. In these patients obstructive sleep apnea syndrome (OSAS) is frequently present. Although patients with OSAS are at increased risk for hypoxemia, the impact of postoperative nasal packing (PNP) on sleep-disordered breathing and oxygen desaturations in patients with OSAS is unknown. We consecutively investigated 40 patients undergoing endonasal surgery receiving PNP. Fifteen of these patients had previously diagnosed OSAS (Group 2) and 25 did not (Group 1). In the control group, 12 healthy patients underwent elective ear or neck surgery without PNP. During the preoperative and postoperative nights, we continuously measured oronasal flow, thoracoabdominal movements, and oxygen saturation. We calculated the apnea-hypopnea index (AHI) and the oxygen-desaturation index (ODI). Compared with the preoperative values, after the operation, neither AHI nor ODI changed in the control group. In contrast, in Group 1, AHI (from 11 [5-19] to 37 [22-49]) and ODI (from 4 [2-8] to 13 [6-21]) significantly increased (P < 0.05), whereas in Group 2, only AHI significantly increased (from 14 [10-21] to 39 [26-50]); ODI remained similar (13 [8-27] versus 11 [4-37]). Because ODI did not increase in patients with OSAS and PNP who received postoperative oxygen overnight, postoperative intensive care monitoring might not be necessary on a routine basis for all patients with PNP and OSAS.

Topics: Adult; Anesthesia, General; Female; Hemostatic Techniques; Humans; Male; Middle Aged; Nasal Obstruction; Nose; Otorhinolaryngologic Diseases; Oxygen; Polysomnography; Postoperative Hemorrhage; Pulmonary Ventilation; Respiration; Sleep Apnea, Obstructive; Tampons, Surgical

The objective of this study was to observe the change in CPAP pressure after nasal and/or tonsil surgery in a retrospective study involving 17 patients unable to tolerate CPAP titration. All patients had two polysomnography studies for titration: one before and another subsequent to upper airway surgical treatment. The results showed a mean age of 49 +/- 9 years, a body mass index of 30 +/- 4 kg/m(2) and an apnea-hypopnea index of 38 +/- 19. Surgical procedures were radiofrequency reduction of the inferior turbinate (eight patients), septoplasty (one patient), septoplasty with inferior turbinectomy (two patients), septoplasty with inferior turbinate submucosal diathermy (two patients), septoplasty with tonsillectomy (two patients), septoplasty with inferior turbinate submucosal diathermy and tonsillectomy (one patient) and tonsillectomy (one patient). CPAP titration before and after surgery had respectively a mean pressure of 12.4 +/- 2.5 and 10.2 +/- 2.2 cmH(2)O ( P = 0.001). Maximum CPAP pressure was 16.4 cmH(2)O before and 13 cmH(2)O after surgery. A pressure reduction > or =1 cmH(2)O occurred in 76.5% of the patients and > or =3 cmH(2)O in 41.1%. Upper airway surgical treatment appears to have some benefit by reducing nasal CPAP pressure levels. The effect seems to be greater when the prior pressure was > or =14 cmH(2)O.

Topics: Adult; Continuous Positive Airway Pressure; Female; Humans; Male; Middle Aged; Nose; Otorhinolaryngologic Surgical Procedures; Palatine Tonsil; Polysomnography; Pressure; Retrospective Studies; Sleep Apnea, Obstructive; Tonsillectomy

The aim of this study was to measure craniofacial morphology and nasal respiratory resistance (NRR) in Malay, Indian and Chinese subjects with obstructive sleep apnoea (OSA). The sample consisted of 34 male subjects, 27-52 years of age (Malay n = 11, which included five mild and six moderate-severe OSA; Indian n = 11, which included six mild and five moderate-severe OSA; and Chinese n = 12, which included six mild and six moderate-severe OSA) diagnosed using overnight polysomnography. After use of a decongestant, NRR was recorded using anterior and posterior rhinomanometry. Standardized lateral cephalometric radiographs were used to record linear and angular dimensions. Malay subjects with moderate-severe OSA had a shorter maxillary (sp-pm) and mandibular (gn-go) length when compared with a mild OSA reference sample (P < 0.05). The hyoid bone was located more caudally in the Chinese moderate-severe subjects (hy-NL, hy-ML)(P < 0.05), and may be a useful diagnostic indicator for severity in this racial group. No pattern of differences for NRR was seen between the moderate-severe and mild OSA subjects. The consistently lower values for nasopharyngeal resistance in all the moderate-severe subjects when compared with the mild group may indicate that some compensation at this level of the airway had taken place. Strong positive correlations between craniocervical angulation (NL/OPT) and total airway resistance and the turbulent component of flow (k(2)) suggest that head posture is sensitive to fluctuations in airway resistance (P < 0.01).

Topics: Adult; Airway Resistance; Asian People; Cephalometry; China; Ethnicity; Facial Bones; Head; Humans; Hyoid Bone; India; Malaysia; Male; Mandible; Manometry; Maxilla; Middle Aged; Nasal Decongestants; Nose; Posture; Skull; Sleep Apnea, Obstructive; White People

To validate the technique of sleep nasendoscopy using target controlled infusion in symptomatic patients and a control group of asymptomatic individuals.. Prospective cohort study.. Department of otolaryngology-head and neck surgery and anesthesia in a teaching hospital.. Two groups of patients were compared and matched for their body mass index. The first group consisted of 53 patients with a history suggestive of obstructive sleep apnea. The second group consisted of 54 patients with partner-confirmed history of no snoring. These patients were undergoing anesthesia for other reasons. Both groups of patients were free of associated otorhinolaryngologic symptoms.. Assessment of production of snoring or obstruction in patients with no documented history of snoring when sedation was administered as part of general anesthesia using target controlled infusion with propofol.. None of the patients in the asymptomatic group snored or obstructed at any level of propofol, and this was clearly significant on comparison with the symptomatic group (P < .001). All of the symptomatic patients were induced to become symptomatic (snoring/obstruction).

Topics: Body Mass Index; Case-Control Studies; Endoscopy; Female; Humans; Hypnotics and Sedatives; Male; Middle Aged; Nose; Propofol; Prospective Studies; Reproducibility of Results; Sleep; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Snoring

This prospective, cohort study evaluated the role of sleep nasendoscopy (SNE) with simultaneous mandibular protrusion in predicting successful mandibular advancement splint (MAS) therapy in subjects with obstructive sleep apnoea (OSA). Nineteen OSA subjects diagnosed by overnight polysomnography were referred for MAS therapy, following SNE investigation. A Herbst MAS was fabricated for each subject. Once this had been adjusted for maximal, subjective, therapeutic effect, follow-up sleep studies were undertaken with the appliance in situ. The SNE was repeated with the appliance in place to allow the effects of the original mandibular protrusion and the actual effect of the MAS to be compared. The MAS was removed and the original and current site(s) of obstruction evaluated. Pre-treatment SNE showed airway obstruction at the following levels: intermittent multi-level (16 subjects), sustained multi-level (two subjects) and tongue base (one subject). In all individuals, gentle advancement of the mandible during SNE improved airway patency and reduced snoring. When the SNE was repeated with the MAS in situ, all subjects showed improvements in snoring and airway patency. Follow-up sleep studies confirmed the efficacy of the MAS, with all patients showing a reduction in the apnoea/hypopnoea index (AHI). Median reductions in AHI (from 28.1 to 6.1, P < 0.001) and Epworth Sleepiness Scale (ESS) scores (from 9 to 6, P < 0.001) were highly statistically significant. The results suggest that SNE with concomitant mandibular advancement to mimic MAS wear, could be a valuable prognostic indicator of successful MAS treatment.

Topics: Adult; Aged; Airway Obstruction; Cohort Studies; Endoscopy; Female; Follow-Up Studies; Forecasting; Humans; Male; Mandibular Advancement; Middle Aged; Nose; Occlusal Splints; Orthodontic Appliances, Functional; Polysomnography; Prospective Studies; Pulmonary Ventilation; Sleep; Sleep Apnea, Obstructive; Sleep Stages; Snoring; Treatment Outcome

The purpose of this study was to evaluate mandibular lengthening by distraction osteogenesis (DO) to achieve decannulation of micrognathic children with "permanent" tracheostomies.. Using a retrospective chart review, patients were included who had 1 ) airway compromise/tracheostomy, 2 ) micrognathia, 3 ) polysomnography-documented obstructive apnea, and 4 ) mandibular advancement using DO. Excluded were 1 ) adults, 2 ) neonates without tracheostomy, and 3 ) patients with central apnea. Patient age, past medical history, age at tracheostomy, and distraction protocol were documented. Oxygen saturation, posterior airway space (in millimeters), and sella-nasion-B point (SNB) angle were recorded. The distraction protocol consisted of a latency of 48 hours and a rate of 1 mm/day.. There were 5 children, aged 2 to 14 years, who received a tracheostomy between ages 2 and 36 months for airway obstruction. All patients underwent bilateral mandibular distraction using semiburied, unidirectional devices. The average latency was 58 hours, the rate was 1 mm/day, the duration of fixation was 40 to 60 days, and the magnitude of advancement was 23 mm. Healing was evaluated by clinical, radiologic, and ultrasound examinations. No complications were experienced. Mean follow-up was 3.2 years. Postdistraction sleep studies demonstrated no obstructive apneic events and a mean oxygen saturation of 98% (preoperative, 76%, P < .005). Cephalometric values improved: posterior airway space 4 to 14 mm; SNB 66 degrees to 72 degrees ( P < .005 for both variables). Four of the 5 patients have been successfully decannulated to date.. The results of this preliminary study indicate that mandibular advancement by DO is a potentially viable treatment option for tracheostomy-dependent children with upper airway obstruction secondary to micrognathia.

Topics: Adolescent; Airway Obstruction; Cephalometry; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Male; Mandible; Mandibular Advancement; Micrognathism; Nose; Osteogenesis, Distraction; Oxygen; Polysomnography; Retrospective Studies; Sella Turcica; Sleep Apnea, Obstructive; Tracheostomy; Treatment Outcome; Wound Healing

Topics: Antioxidants; Gastroesophageal Reflux; Humans; Nasal Obstruction; Nose; Oxidative Stress; Sleep Apnea, Obstructive; Treatment Outcome

The efficacy of the nasobuccal thermistor (NT) was compared with the nasal pressure cannula (NC) and the calibrated, time-differentiated respiratory inductance plethysmography sum signal (DS) in the detection of obstructive events in children during polysomnography (PSG). The overnight PSG of 20 consecutive referrals were selected for analysis. Obstructive events were scored in each study three times by one operator using a blinded procedure whereby either the NT, the NC or the DS was visible. The standard PSG channels were also visible. SPSS software was used for statistical analysis. Twenty patients aged 5 weeks to 16 years were studied. Agreement in obstructive apnoea-hypopnoea index (OAHI) was highest between the NT and NC, and the NC and DS. The NC signal was significantly more likely to be uninterpretable than the NT (P = 0.02) and this did not correlate with age. Event detection by the NT was significantly improved by the addition of either the NC (P = 0.01) or the DS (P = 0.001), while the NC stood alone unless the DS was added (P = 0.02). There was no significant difference in OAHI by the NC versus the DS. The NC detected significantly more OA than the NT or the DS (P = 0.04), while the DS trended towards detecting more OH. There was no significant difference in OAHI between any combination pair. The nasal cannula and differentiated sum signal perform better as measures of paediatric airflow than the NT. To optimize the detection of obstructive events in children we recommend using at least one, if not both these methods in paediatric sleep laboratories.

Topics: Catheterization; Child; Humans; Nose; Plethysmography; Polysomnography; Respiration; Severity of Illness Index; Sleep Apnea, Obstructive

To determine the safety of same-day discharge for patients who undergo combined nasal and palatal surgery for obstructive sleep apnea syndrome, we undertook a retrospective review and analysis of 2 groups of patients (total, 86 patients) who underwent such surgery. The patients with obstructive sleep apnea syndrome who underwent combined nasal and palatal surgery were considered for same-day discharge if they fulfilled the following postoperative criteria: sustained O2 saturation of 94% or greater on room air while asleep, no history of cardiopulmonary disease or diabetes mellitus, adequate oral analgesia and oral intake, hemostasis, and normal vital signs. Twenty-three patients met these criteria and were assigned to group 1. The remaining 63 patients were admitted overnight for monitoring and were assigned to group 2. The data collected included patient demographics, respiratory disturbance index, lowest O2 saturation, body mass index, and postoperative complications. The mean age, respiratory disturbance index, lowest O2 saturation, and body mass index for group 1 were 45.9 years, 36 events per hour, 84.9%, and 28.7 kg/m2, respectively. For group 2, the results were 48 years, 36.5 events per hour, 82%, and 32.5 kg/m2. There were no postoperative complications in group 1, and 3 in group 2. There were no incidents of airway compromise or cardiopulmonary events in the immediate postoperative period in either group. There were no readmissions for either group. We conclude that same-day discharge for patients who have undergone combined nasal and palatal surgery for obstructive sleep apnea syndrome is relatively safe in selected cases in which significant comorbid diseases are not present. These selected cases would have constituted a minority of the patients studied.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ambulatory Surgical Procedures; Female; Hospitalization; Humans; Male; Middle Aged; Nose; Outcome and Process Assessment, Health Care; Oximetry; Oxyhemoglobins; Palate; Postoperative Complications; Retrospective Studies; Sleep Apnea, Obstructive

Nasal continuous positive airway pressure (CPAP) is the mainstay of treatment for patients with moderate to severe obstructive sleep apnoea (OSA). However, tolerance and compliance are poor. An audit using the Christchurch Hospital ORL surgery database identified patients who underwent upper airway surgery for OSA. Tracheostomy and bimaxillary advancement patients were excluded. Adults with moderate to severe OSA (Desaturation Index (DI) >10 n.h(-1)), who had failed a trial of nasal CPAP, and had pre-operative and post-operative sleep study data were identified. Objective (DI) and Subjective (Epworth Sleepiness Score (ESS)) outcome measures were recorded. The database identified 69 patients who underwent surgery for snoring or OSA; of these, 25 patients formed the study group. Sixteen out of 25 improved (64 per cent) after surgery, seven out of 25 showed no change (28 per cent), two patients (eight per cent) showed deterioration in their DI. Forty-eight per cent of patients had >50 per cent post-operative improvement in DI. Fourteen out of 25 (56 per cent) had a post-operative DI <20 n.h(-1). Seven out of 25 (28 per cent) had a post-operative DI <10 n.h(-1). Upper airway surgery has a role in the management of selected patients with OSA who cannot tolerate nasal CPAP.

Topics: Adult; Aged; Contraindications; Humans; Male; Medical Audit; Middle Aged; Nose; Oxygen; Patient Compliance; Pharynx; Positive-Pressure Respiration; Sleep Apnea, Obstructive; Treatment Outcome

Topics: Adenoidectomy; Humans; Nose; Palate, Soft; Pharynx; Sleep Apnea, Obstructive; Tongue; Tonsillectomy; Uvula

Recent laser and radiofrequency techniques for the treatment of snoring have provided improvements, but intraoperative and postoperative risks, complications, and long-term results have not been explored in a statistically large enough sample of patients. The goal of this article is to provide practitioners with important data and guidelines to help them in decision-making and prepare them to anticipate problems and recommend a systematic approach to avoid or treat complications.. This investigation was a retrospective review of 5,600 cases, performed over a 10-year period by a single investigator, in a private practice setting. The data on complications were gathered from chart review as well as questionnaires filled out on each patient and by patient reports. The inclusion criteria for this review were: 1) patients with a history of chronic snoring or nasal congestion; 2) patients with an American Society of Anesthesiologists physical status classification (ASA) Classes I or II medical history; 3) patients provide a detailed preoperative snoring questionnaires; 4) patients provide informed consent; 5) patients were followed for a minimum of 2 years following surgery; 6) patients completed a comprehensive postoperative survey; 7) operative report stating the exact nature of any complications; 8) surgeons provided a clinical assessment; 9) sleep apnea reports if available; and 10) patient body mass index of less than 30 kg/m2.. Laser-assisted uvulopalatopharyngoplasty (LA-UPPP) was used for the treatment of snoring and mild obstructive sleep apnea in all cases; 40% of patients also had simultaneous nasal radioablation. No fatalities were recorded and fewer than 3% of patients had long-term complications. The most common intraoperative complication was bleeding, which occurred in 9.5% of patients.. Reducing the amount of tissue resected from the soft palate helped reduce or eliminate the common complications of traditional uvulopalatopharyngoplasty procedures. LA-UPPP and radioablation procedures are effective, safe, and can be carried out in an office setting equipped with anesthesia monitors and services. The complications associated with the procedure were rare and usually manageable.

Topics: Adult; Aged; Blood Loss, Surgical; Catheter Ablation; Chronic Disease; Female; Follow-Up Studies; Hiccup; Humans; Laser Therapy; Male; Middle Aged; Nose; Nose Diseases; Palate, Soft; Pharynx; Postoperative Complications; Retrospective Studies; Rhinitis; Safety; Sleep Apnea, Obstructive; Snoring; Treatment Outcome; Uvula

The relationship between maxillary constriction and the etiology of obstructive sleep apnea (OSA) is not clear. This prospective case-control study compared maxillary morphology in 94 dentate subjects (47 OSA and 47 control subjects), using upright lateral cephalograms and study models. Each subject had height, weight, and neck circumference measurements recorded and underwent an orthodontic examination. An upright lateral cephalogram and dental impressions were obtained. All data were analyzed using the SPSS statistical package applying nonparametric tests at the 5% level of significance. Male and female subjects were examined separately, and statistically significant differences were found between the cephalometric measurements for OSA and the control subjects. The palatal angle was more obtuse in male OSA subjects (P < .05). The PNS-posterior pharyngeal wall was shorter (P < .05) and the soft palate longer in female OSA subjects (P < .05). Minimum palatal airway widths were significantly reduced in both male (P < .01) and female (P < .001) subjects. In the comparison of study model measurements, palatal heights in OSA subjects were greater (P < .05). Thus, maxillary morphological differences do exist between OSA and control subjects, supporting their role as a etiological factor.

Topics: Adult; Body Height; Body Weight; Case-Control Studies; Cephalometry; Female; Humans; Male; Maxilla; Middle Aged; Models, Dental; Neck; Nose; Palate; Palate, Soft; Pharynx; Prospective Studies; Sex Factors; Sleep Apnea, Obstructive; Statistics, Nonparametric

In this communication, we report the current status of OSAS (Obstructive Sleep Apnea Syndrome) in the southern region of Higashikatsushika around Ichikawa City, our effort to improve patient QOL as well as to establish diagnostic and therapeutic methods, and the results of a comparison of therapeutic options with the focus on improvement of compliance by using nCPAP (nasal continuous positive airway pressure). We examined 112 patients who visited the Otolaryngology Department at Tokyo Dental College, Ichikawa General Hospital, with the chief complaint of nocturnal snoring or sleep apnea from January 2001 to April 2003 and underwent all-night PSG (polysomnography). Based upon the results of these all-night PSGs, 89 and 23 patients were diagnosed as having OSAS and simple snoring, respectively. Using the AHI classification of severity, 58 and 31 patients were assessed as having severe OSAS and mild OSAS, respectively. (1) nCPAP was tried in 61 patients, and 39 patients (63%) were able to continue it. After the introduction of nCPAP, surgery was performed in 18 patients (30%). As a result, weaning from nCPAP was successfully achieved in 10 cases, compliance with nCPAP was improved in six cases, alleviation of symptoms (decreased pressure) was seen in one case, and aggravation was noted in one case. In addition, four patients (7%) unilaterally discontinued nCPAP. (2) Surgery was performed in 34 patients, and 18 of them had surgery after nCPAP was tried. (3) We asked the dental department to make OAs (oral appliances) for 31 patients but seven of them did not attend the department, so a total of 24 patients used OAs. Fourteen patients (58%) were able to tolerate an OA for 3 months or more. Based on these results, we are hoping to achieve a better control of OSAS by combining nCPAP and other modalities.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Combined Modality Therapy; Continuous Positive Airway Pressure; Endoscopy; Female; Humans; Male; Middle Aged; Nose; Orthodontic Appliances; Patient Compliance; Polysomnography; Quality of Life; Sleep Apnea, Obstructive; Snoring; Tokyo; Treatment Outcome; Ventilator Weaning

A 31-year-old man who had been diagnosed with obstructive sleep apnea syndrome (OSAS) due to retrognathia was referred to our hospital. Before treatment, the angle of the sella-nasion-point B (SNB) was 67 degrees. The lowest oxygen saturation (SpO2) during sleep was 77%, the longest-running episode of sleep apnea was 128 seconds, and his apnea index (AI) was 29.9. He underwent bilateral horizontal mandibular distraction osteogenesis using intraoral distraction devices. After mandibular distraction, SNB increased to 72 degrees. The lowest SpO2 during sleep increased to 85%, the longest-running episode of sleep apnea decreased to 40 seconds, and his AI decreased to 4.1 (within normal range). No marked recurrence of OSAS was observed even at one year after mandibular distraction. This report suggests that mandibular lengthening by distraction osteogenesis is an effectual method for the treatment of OSAS due to retrognathia.

Topics: Adult; Cephalometry; Follow-Up Studies; Humans; Internal Fixators; Male; Malocclusion, Angle Class II; Mandible; Nose; Osteogenesis, Distraction; Oxygen; Polysomnography; Retrognathia; Sella Turcica; Sleep Apnea, Obstructive; Time Factors; Treatment Outcome

One hundred and twenty-three patients with snoring problems and/or obstructive Sleep Apnea Syndrome (OSAS) were offered Rhinosleep Flextube-reflectometry during sleep registration to assess the upper airway. The main point of interest was patient acceptance of the procedure. 36 patients with OSAS received Rhino Flextube reflectometry. Of these, 19 (53%) completed a whole night registration with the Rhinosleep tube and 17 (47%) did not. This low success rate is multifactorial and will be discussed in detail in the text. The development of Rhinosleep is a challenge, as it improves the topical diagnostic work-up of OSAS patients. At present however various practical problems have to be solved to make it a viable alternative to sleep endoscopy.

Topics: Endoscopy; Feasibility Studies; Humans; Intubation; Nose; Polysomnography; Rhinometry, Acoustic; Sleep Apnea, Obstructive; Snoring

The study goal was to determine the safety of performing same-stage nasal and palatopharyngeal surgery for the treatment of obstructive sleep apnea syndrome (OSAS).. We conducted a retrospective review of 91 consecutive patients who underwent surgery for OSAS at tertiary care facilities.. Patients were divided into 2 groups: group 1 had same-stage nasal and palatopharyngeal surgery (n = 63), whereas group 2 had palatopharyngeal surgery at a stage separate from the nasal surgery (n = 28). Patient demographics, severity of OSAS, type of surgery, perioperative care, and postoperative complications were reviewed.. There were 55 men and 8 women in group 1, with an average age of 48 years. Group 2 consisted of 20 men and 8 women, with an average age of 45 years. The mean respiratory disturbance index was 36.5 and 33.5 for group 1 and 2, respectively. The mean lowest arterial Oxygen saturation for group 1 was 82%, whereas that of group 2 was 81%. Patients in both groups were observed in a hospital setting for a minimum of 1 day. They were admitted to a room close to the nurse's station, with continuous pulse oximeter monitoring. There were 3 complications reported for group 1: pneumonia (1 patient, postoperative day 4), tonsil bleed (1 patient, postoperative day 6), and septal hematoma (1 patient). One patient in group 2 had a tonsil bleed (postoperative day 8). There were no incidents of airway compromise or cardiopulmonary events in the immediate postoperative period.. Same-stage nasal and palatopharyngeal surgery for OSAS is safe. Patients could be monitored with continuous pulse oximetry and managed outside of an intensive care unit setting in the immediate postoperative period.

Topics: Case-Control Studies; Comorbidity; Female; Humans; Male; Middle Aged; Monitoring, Physiologic; Nose; Oximetry; Palate; Pharynx; Postoperative Complications; Retrospective Studies; Sleep Apnea, Obstructive; Uvula

Respiratory disturbances in patients with the sleep apnea-hypopnea syndrome (SAHS) may be detected by means of nasal prongs (NP) pressure (PNP). Nevertheless, PNP is nonlinearly related to flow (V). Our aim was to demonstrate the relevance of linearizing P NP for assessing hypopneas and flow limitation in SAHS. V was measured with a pneumotachograph during the hypopneas and flow limitation events in a continuous positive airway pressure (CPAP) titration in six patients with severe SAHS. These flow patterns were reproduced by a flow generator through an analog of the nares and recorded by NP. PNP was linearized [V NP = (PNP)1/2] by a specially designed analog circuit. For each event we used V, P NP, and V NP to compute the hypopnea flow amplitude (HFA) and a flow limitation index (FLI). Owing to NP nonlinearity, PNP considerably misestimated HFA and FLI. By contrast, V NP provided HFA and FLI values that were very close to those obtained from V: HFA (V NP) = 1.098. HFA(V) - 0.063 (r2 = 0.98) and FLI(V NP) = 1.044. FLI(V) + 0.004 (r2 = 0.99). Square-root linearization of NP greatly increases the accuracy of quantifying hypopneas and flow limitation. This procedure, which could be readily carried out in routine practice by means of the analog circuit we developed, is of interest in optimizing the assessment of respiratory sleep disturbances in SAHS.

Topics: Computers, Analog; Equipment Design; Humans; Nose; Polysomnography; Positive-Pressure Respiration; Pulmonary Ventilation; Reproducibility of Results; Signal Processing, Computer-Assisted; Sleep Apnea, Obstructive; Transducers, Pressure

The goal was to compare the effect of an improved nasal airway on obstructive sleep apnea (OSA) by use of subjective and objective measures.. A prospective study of 50 consecutive patients with nasal airway obstruction and OSA was carried out.. Subjectively, nasal breathing improved in 49 (98%) patients, whereas snoring decreased or disappeared in 17 (34%); the remaining 33 (66%) patients did not notice any significant change in their snoring. Daytime energy levels increased in 39 (78%) patients and remained unchanged or worsened in 11 (22%). In review of the polysomnographic data, the group overall did not have significant changes in respiratory disturbance index (RDI) or lowest oxygen saturation levels (LSaO(2)). Continuous positive airway pressure (CPAP) levels required to correct OSA decreased after nasal surgery (P < 0.01). Patients with mild OSA showed significant worsening in RDI (P < 0.05), whereas LSaO(2) levels were improved in the group with moderate OSA (P < 0.05). In patients with severe OSA neither the RDI levels nor the LSaO(2) changed, but CPAP levels required to alleviate the obstruction after surgery were reduced (P < 0.01).. Most patients report improvement in nasal and sleep symptoms after correction of nasal airway obstruction. However, nasal surgery alone does not consistently improve OSA when measured objectively. Depending on the severity of OSA, nasal airway reconstruction may contribute to a decrease in CPAP level and improvement in oxygen saturation. Correction of the obstructed nasal airway should certainly be included in the overall treatment plan for OSA.

Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Nasal Obstruction; Nose; Polysomnography; Positive-Pressure Respiration; Prospective Studies; Respiration; Sleep Apnea, Obstructive; Snoring

This study was aimed to examine the short- and long-term effects of nasal continuous positive airway pressure (CPAP) on the chemosensitivity to hypoxia and hypercapnia in the patients with obstructive sleep apnea (OSA). Awake ventilatory responses to hypoxia and hypercapnia were examined in 28 patients (3 female) with moderate to severe OSA. All these tests were examined before and after 2 weeks of nasal CPAP. In 10 patients these tests were repeated after 3-6 months of nasal CPAP. All were also tested for spirometry and arterial blood gas analysis. Patients were middle-aged (48.9 +/- 9.9 years) and their mean apnea-hypopnea index was 58.3 +/- 20.4/hour. After 2 week of nasal CPAP, PaO2 significantly increased (77.7 +/- 11.8 vs. 84.6 +/- 9.8 mmHg) and PaCO2 significantly decreased (44.9 +/- 3.8 vs. 42.3 +/- 3.7 mmHg). The ventilatory response to hypoxia significantly decreased (0.80 +/- 0.51 vs. 0.61 +/- 0.51 liter/min/%) whereas the ventilatory response to hypercapnia significantly increased after 2 weeks (1.47 +/- 0.73 vs. 1.80 +/- 0.76 liter/min/mmHg). Similar findings were also observed after 3-6 months of nasal CPAP in 10 OSA patients. Nasal CPAP treatment can alter the ventilatory responses in patients with OSA.

Topics: Blood Gas Analysis; Female; Forced Expiratory Volume; Humans; Hypercapnia; Hypoxia; Male; Middle Aged; Nose; Positive-Pressure Respiration; Pulmonary Ventilation; Sleep Apnea, Obstructive; Spirometry

Individuals with obstructive sleep apnea (OSA) require increased pharyngeal muscle dilator activation during wakefulness to maintain upper airway patency. Negative pressure is one potential stimulus for this neuromuscular compensation. Individuals with OSA who have previously undergone tracheostomy provide an opportunity to study upper airway physiology in both the presence and absence of upper airway respiratory stimuli. If negative pressure (or another local airway stimulus) were important in driving pharyngeal dilator muscle activation, one would predict that during nasal breathing, the pharynx of a tracheostomized patient would be exposed to negative pressure, and that high levels of muscle activation would therefore be measured. Conversely, during breathing by the patient through the tracheal stoma, one would expect low levels of muscle activation in the absence of local stimuli. We measured a number of respiratory variables, including genioglossus activation under both nasal and tracheal stomal breathing conditions, in five patients. In all five patients there was a significant and substantial decrease in both peak phasic (100 +/- 0 to 53.4 +/- 9.2 arbitrary units [mean +/- SEM], p < 0.01) and tonic genioglossus activation (36.3 +/- 5.3 to 20.7 +/- 3.9 arbitrary units, p < 0.05) during stomal breathing as compared with nasal breathing. We conclude that local upper airway respiratory stimuli, possibly negative pressure, are important in mediating the increased pharyngeal dilator muscle activation seen in sleep apnea patients during wakefulness.

Topics: Airway Resistance; Electromyography; Female; Humans; Male; Middle Aged; Nose; Pharyngeal Muscles; Pressure; Pulmonary Ventilation; Reflex; Respiration; Sleep Apnea, Obstructive; Tongue; Tracheostomy

This prospective study analysed the upright lateral cephalometric radiographs of 115 dentate, Caucasian males. Forty-five subjects exhibited proven obstructive sleep apnoea (OSA), 46 were simple snorers, and the remaining 24 subjects, who had no history of respiratory disease and did not snore, acted as controls. Radiographs were traced and digitized, and comparisons were made of the dento-skeletal, soft tissue, and oropharyngeal features of the three groups. Differences were also sought between the snoring and OSA subjects. Of the hard tissue measurements, only the cranial base angle and mandibular body length showed significant inter-group differences (P < 0.001 and P < 0.05, respectively). When the airway and associated structures were examined, both snorers and OSA subjects exhibited narrower airways, reduced oropharyngeal areas, shorter and thicker soft palates, and larger tongues than their control counterparts. Comparison of the two sleep disordered breathing groups showed no differences in any of the skeletal or dental variables examined. However in OSA subjects, the soft palate was larger and thicker (P < 0.05), both lingual and oropharyngeal areas were increased (P < 0.01 and P < 0.05, respectively) and the hyoid was further from the mandibular plane (P < 0.05). Thus, whilst the dento-skeletal patterns of snorers resembled those of subjects with OSA, some differences in soft tissue and hyoid orientation were apparent. There was not, however, a recognizable gradation in size of the airway and its associated structures from control through snoring to OSA subjects. This suggests that there may be a cephalometrically recognizable predisposition towards the development of sleep disordered breathing, but that this is only one facet of the condition.

Topics: Adult; Aged; Body Mass Index; Case-Control Studies; Cephalometry; Discriminant Analysis; Humans; Hyoid Bone; Male; Middle Aged; Nasal Obstruction; Nose; Oropharynx; Palate, Soft; Prospective Studies; Reference Values; Skull Base; Sleep Apnea, Obstructive; Snoring; Tongue

Obstructive sleep apnea syndrome is common in middle-aged men and may be associated with an increased risk of cardiovascular disease. We investigated the effect of nasal continuous positive airway pressure (CPAP) treatment on levels of soluble cell adhesion molecules-which have been shown to be associated with the development of atherosclerosis-in these patients.. We studied 23 patients with obstructive sleep apnea syndrome diagnosed by polysomnography who were treated with nasal CPAP. Serum soluble intercellular adhesion molecule-1, E-selectin, and vascular cell adhesion molecule-1 levels were measured before nasal CPAP was started, and after 3 or 4 days (n = 19), 1 month (n = 23), or 6 months (n = 11) of treatment.. After 3 to 4 days of nasal CPAP therapy, the mean (+/- SD) soluble E-selectin level had decreased from 89 +/- 44 ng/mL to 69 +/- 28 ng/mL (P = 0.002). After 1 month, the soluble intercellular adhesion molecule-1 level had decreased from 311 +/- 116 ng/mL to 249 +/- 74 ng/mL (P = 0.02). After 6 months, soluble vascular cell adhesion molecule-1 levels had not changed significantly, while the mean soluble intercellular adhesion molecule-1 level (212 +/- 59 ng/mL) had decreased further (P = 0.02). Before treatment, soluble intercellular adhesion molecule-1 levels and the apnea and hypopnea index were correlated (r = 0.43, P = 0.04).. Obstructive sleep apnea and hypopnea have a significant adverse effect on serum soluble cell adhesion molecule-1 levels that may be reduced by nasal CPAP treatment.

Topics: Adult; Body Weight; Cardiovascular Diseases; Cell Adhesion Molecules; Cholesterol; E-Selectin; Humans; Intercellular Adhesion Molecule-1; Male; Middle Aged; Nose; Polysomnography; Positive-Pressure Respiration; Risk; Risk Factors; Sleep Apnea, Obstructive; Sleep Stages; Time Factors; Vascular Cell Adhesion Molecule-1

Epidemiological studies have implicated obstructive sleep apnea (OSA) as an independent comorbid factor in cardiovascular and cerebrovascular diseases. The recurrent episodes of occlusion of upper airways during sleep result in pathophysiological changes that may predispose to vascular diseases, and we postulate that nitric oxide may be one of the mediators involved. This study investigates the levels of circulating nitric oxide (NO), measured as serum nitrites and nitrates, in the early morning in OSA subjects compared with control subjects, and the effect of overnight nasal continuous positive airway pressure (nCPAP) in OSA subjects. Thirty men with moderate to severe OSA (age = 41.9 +/- 9.0; apnea-hypopnea index, AHI = 48.0 +/- 18.1) were compared with 40 healthy men (age = 40.6 +/- 5.4; AHI = 1.4 +/- 1.2). Serum nitrite/nitrate levels were significantly lower in OSA subjects (OSA = 38.9 +/- 22.9 microM, control subjects = 63.1 +/- 47.5 microM, p = 0.015). There was significant negative correlation between serum nitrites/nitrates and the following parameters: AHI (r = -0.389, p = 0.001), oxygen desaturation time (r = -0.346, p = 0.004), and systolic blood pressure (BP) (r = -0.335, p = 0.005). Stepwise multiple linear regression with systolic or diastolic BP as the dependent variable identified serum nitrites/nitrates as the only significant correlate. Twenty-two OSA subjects had measurements of serum NO at baseline and after an overnight application nCPAP. There was significant increase in serum NO after nCPAP (baseline = 30.5 +/- 14.4 microM, after nCPAP = 81.0 +/- 82.1 microM, p = 0.01). This study demonstrates, for the first time, that circulating NO is suppressed in OSA, and this is promptly reversible with the use of nCPAP. The findings offer support for nitric oxide being one of the mediators involved in the acute hemodynamic regulation and long-term vascular remodeling in OSA.

Topics: Adult; Humans; Linear Models; Male; Middle Aged; Nitric Oxide; Nose; Polysomnography; Positive-Pressure Respiration; Sleep Apnea, Obstructive; Statistics, Nonparametric