Decrease In AHI Research Articles

Coblator Assisted-Barbed Relocation Pharyngoplasty (Co-BRP) in Obstructive Sleep Apnea Surgical Treatment.

Barbed reposition pharyngoplasty (BRP) is a new technique to manage velo-pharyngeal obstruction and collapse in OSA patients. Tonsillectomy is a preliminary step of BRP surgery. Dissection of the PPM with monopolar or hot instruments is an essential step of the BRP technique. Tonsillectomy and muscle manipulation should be managed with careful attention due to the risk of muscle fibers rupture and surgical failure. We describe the coblator assisted BRP. The aim of this paper is to report the use and advantages of coblator technology in tonsillectomy and the velo-pharyngeal dissection before the PPM relocation with barbed sutures. In this operative technique study 100 OSA patients underwent Co-barbed technique. The CO-BRP technique has been considered fast, safe and minimally invasive with a low postoperative pain (mean value 3.63 ± 0.7). Postoperatively, a significant decrease in mean AHI from 35.63 ± 10.57 to 17.06 ± 5.92 (P < .005) emerged.

Effects of twin-block appliance on upper airway parameters in OSA children with class II malocclusion and mandibular retrognathia: a CBCT study.

Correction of class II mandibular retrognathic skeletal malocclusion with twin-block appliance resulted in a significant increase in upper airway volume, MCA, anteroposterior and lateral distances of the MCA at the level of the oropharynx, MCA at the level of the hypopharynx and upper airway length, and a significant decrease in AHI, but it had no effect on nasopharynx parameters. • CBCT imaging has been shown to be an effective and precise diagnostic tool for analyzing the upper airways and craniofacial structures. • Twin block appliance may be an effective treatment modality in children with OSA. • Minimal cross-sectional area of upper ways may be the most relevant potential parameter when explaining how the upper airway anatomy plays role of in the pathogenesis of pediatric OSA. • Twin block appliance induced favorable changes in upper airway morphology (oropharynx area mainly) and respiratory parameters in OSA children with class II malocclusion.

0474 Observing the Changes of Tongue and Airway Configurations in Responders of Mandibular Advancement Device Using Ultrasound Imaging

Abstract Introduction Mandibular advancement device (MAD) is designed to pull the mandible and the tongue forward anteriorly to increase the cross-sectional airway dimension and thus possibly reduce airway obstructions during sleep. The effectiveness of a MAD may be affected by the pre-treatment OSA severity, BMI, and degree of changes in pharyngeal dimensions resulting from the device in situ. In this study, 3D submental ultrasound imaging is applied to evaluate the difference in the tongue and airway configurations between the responders and non-responders of the MAD treatment. Methods In this retrospective study, 31 subjects (25 males, median age/BMI/baseline AHI of 56/24.5/25.3) diagnosed with sleep apnea and underwent tongue-backing-MAD (t-MAD) treatment were consented from the Department of dentistry of National Taiwan University Hospital between April and December 2022 (IRB 202108078RIPD). Changes in the severity of OSA were assessed with polysomnographic studies. Success of t-MAD treatment was defined by an AHI of less than 10 events/hour and at least 50% decrease in AHI from baseline. There were no significant differences in age, BMI, gender and baseline AHI between responders (17) and non-responders (14). While awake and lying in supine position, the tongue and airway configurations at retropalatal and retroglossal regions without and with t-MAD in situ were assessed with standardized 3D submental ultrasound imaging (AmCAD BioMed Corp., Taiwan). Statistical comparisons were performed using t-tests, chi-square tests and nonparametric Mann-Whitney tests. Results The anteroposterior location of the tongue-airway interface at retroglossal region, relative to the superior-inferior location of the soft-palate-airway interface, was found significantly reduced in responders when t-MAD is in situ (p = 0.0078). 13 responders (76.5%) and 9 non-responders (64.3%) were observed with airway width increase in the retroglossal region with t-MAD in situ. However, the difference in airway width changes between responders and non-responders was not statistically significant possibly due to the limited sample size. Conclusion With the real-time visualization and quantitative characterization of the tongue and airway configurations, the 3D submental ultrasound with standardized imaging protocol is able to differentiate the responders from non-responders of the t-MAD treatment and could be a potential tool for treatment response evaluation. Support (if any)

The outcome of oral appliance therapy on position-dependent obstructive sleep apnea: A multicenter randomized controlled trial

<h3>Introduction</h3> This multicenter trial on patients with obstructive sleep apnea (OSA) treated with an oral appliance aimed to determine the effect of sleeping positions. <h3>Methods</h3> A cohort of 314 patients with OSA were enrolled and evaluated at 8 weeks and 1 year, focusing on treatment effects. At baseline and the 2 follow-ups, new polygraphic registration comparing the proportion of treatment responders without position-dependent OSA (non–position-dependent OSA [non-POSA]) and with POSA was used. <h3>Results</h3> At the 8-week and 1-year follow-up, 205 and 139 patients were included, respectively. The proportion of responders (apnea-hypopnea index [AHI] <10 and/or ≥50% reduction in AHI) was 56% for the non-POSA group and 69% for the POSA group (not significant [NS]). The responders increased at the 1-year follow-up: 68% and 77% for the non-POSA and POSA groups (NS), respectively. The absolute change in AHI in all sleeping positions at 8 weeks was –12.9 (interquartile range, –25.0 to –0.5) in the non-POSA group and –10.5 (interquartile range, –19.9 to –5.3; NS) in the POSA group. However, the decrease in supine AHI was significantly greater among subjects with POSA. In contrast, the decrease in nonsupine AHI was significantly greater in the non-POSA group, an effect that remained at the 1-year follow-up. <h3>Conclusions</h3> Our hypothesis that subjects with POSA at baseline would have a higher treatment response rate after oral appliance treatment compared with subjects without POSA was rejected. However, those with POSA had a significantly higher supine AHI decrease, and those without POSA had significantly less nonsupine AHI.

Effect of modified genioglosuss advancement on hyoid bone position: Cephalometric study

ObjectiveTo assess Hyoid bone position and retrolingual airway space after Modified Genioglossus Advancement Surgery by cephalometry in patients with obstructive sleep apnea (OSA). Study designProspective study. SettingZagazig University Hospital. MethodsEighteen patients with moderate to severe OSA having multilevel airway obstruction confirmed by fiberoptic endoscopy during Muller's maneuver and DISE. All patients underwent modified genioglossus advancement surgery associated with antrolateral advancement pharyngoplasty. Beside Polysomnography and Drug induced sleep endoscopy, Cephalometry was done preoperatively and 6 months postoperative. ResultsImproved Polysomnography parameters as Postoperative mean ± SD apnea hypopnea index decreased from 52 ± 17.1 to 17 ± 3 (P < 0.001, 95% confidence interval 27.71 to 42.41). LOS increased from 79.89 ± 4.43% to 83 ± 4.05% (P 0.07, 95% confidence interval −0.31 to 6.97).Cephalometry analysis showed a significant difference between preoperative and postoperative findings, including: Retrolingual airway space at three levels significantly increased; Level 1 from 6.1 ± 1.6 to 8.5 ± 1.7, Level 2 from 10.5 ± 2.4 to 13.9 ± 2.1, Level 3 from 15.7 ± 3.1 to 21 ± 4, H-GN decreased from 51 ± 7 to 39 ± 8, H-MP decreased from 31.6 ± 7.7 to 24.9 ± 7.3, HS decreased from 121 ± 15 to 102 ± 12, H-PH increased from 29 ± 8 to 43 ± 9. With a success rate defined as AHI <20 and a 50% decrease in AHI of the preoperative value, the surgical success rate was 83.33%. ConclusionThis study showed that Modified genioglossus advancement procedures done for OSA patients significantly changed the position of hyoid bone into a more anterior and superior position and this was reflected in the postoperative Polysomnography.

Clinical impact of two types of mandibular retention devices - A CAD/CAM design and a traditional design - On upper airway volume in obstructive sleep apnea patients

ObjectiveThis pilot randomized crossover study evaluated the outcomes of two custom-made mandibular retention devices (MRDs), a computer-aided design (CAD)/computer-aided manufacturing (CAM) device (Narval CC™) and a non-CAD/CAM device (Narval™), on oropharyngeal airway volume in patients with obstructive sleep apnoea (OSA). Methods12 OSA patients were recruited from an University Hospital for MRD therapy with either CAD/CAM or non-CAD/CAM first. A cone-beam computed tomography evaluation (CBCT) and polysomnography assessment was performed during baseline assessment and at the end of each study period. ResultsUpper airway volume increased significantly with the CAD/CAM device (7725 +/- 6540 mm3, p = 0.008) but not with the non-CAD/CAM device (3805 +/- 7806 mm3, p = 0.13). The CAD/CAM device was also associated with a significant decrease in AHI (mean AHI after treatment 9.4±6.7 events/h, p = 0.003) and oxygen desaturation index (mean ODI of ≥ 3%/h 11.9 ± 6.8, p = 0.011). Changes in AHI (14.7 +/- 11.7 events/h, p = 0.083) and ODI (15.5 +/- 19.2, p = 0.074) were not statistically significant with the non-CAD/CAM device. The vertical dimension of occlusion increased significantly following treatment with both MRD devices (both p = 0.003), but was significantly less pronounced with the CAD/CAM device (mean difference: -2.7 +/- 1.7 mm, p = 0.003). Final mandibular protrusion after titration was the same with both devices (85%, p = 0.317). ConclusionThe CAD/CAM (Narval CCTM) device was associated with a significant increase in upper airway volume that may be caused by a lower degree of vertical separation between the jaws when compared to the non-CAD/CAM design.

Study on the structural changes of pharyngeal cavity after bariatric surgery in obese patients with obstructive sleep apnea

Objective:To study whether and how bariatric surgery changes the structure of the pharyngeal cavity in obese patients with obstructive sleep apnea（OSA）. Methods:Forty-two patients who underwent laparoscopic sleeve gastrectomy were recruited. Morphological indicators（BMI, neck and waist circumference）, PSG and acoustic pharyngometry indicators were evaluated pre-operatively and 3, 6, and 12 months post-operatively. Results:All indicators including morphology, pharyngeal cavity structure and OSA severity changed significantly after surgery. Among them, BMI, neck circumference, waist circumference and AHI value were significantly reduced（P<0.001）, while pharyngeal cavity volume, pharynx volume, oropharyngeal junction area, glottis area and LSaO2 increased significantly（P<0.001）. The results of multiple comparisons showed that BMI, neck and waist circumference decreased significantly in the first 6 months, and no further decline occurred during 6 to 12 months postoperatively. The decrease in AHI and LSaO2 mainly occurred within the first 3 months postoperatively, while there was no statistically significant difference in these two indicatiors between 3 months vs. 6 months, 6 months vs. 12 months postoperatively. The area of the oropharyngeal junction increased significantly within 0 to 3 months after surgery, while the volume of the pharyngeal cavity and the area of the glottis increased at 6 months and 12 months after surgery. Conclusion:Bariatric surgery can significantly reduce body weight and reduce fat accumulation in the neck. It can also enlarge the volume and cross-sectional area of the pharyngeal cavity, and improve upper airway obstruction, therefore reduce the symptoms of sleep apnea in obese patients with OSA to a certain extent.

Evaluation of Surgical Learning Curve Effect on Obstructive Sleep Apnea Outcomes in Upper Airway Stimulation.

An increasing number of facilities offer Upper Airway Stimulation (UAS) with varying levels of experience. The goal was to quantify whether a surgical learning curve exists in operative or sleep outcomes in UAS. International multi-center retrospective review of the ADHERE registry, a prospective international multi-center study collecting UAS outcomes. ADHERE registry centers with at least 20 implants and outcomes data through at least 6-month follow-up were reviewed. Cases were divided into two groups based on implant order (the first 10 or second 10 consecutive implants at a given site). Group differences were assessed using Mann-Whitney U-tests, Chi-squared tests, or Fisher's Exact tests, as appropriate. A Mann-Kendall trend test was used to detect if there was a monotonic trend in operative time. Sleep outcome equivalence between experience groups was assessed using the two one-sided tests approach. Thirteen facilities met inclusion criteria, contributing 260 patients. Complication rates did not significantly differ between groups (P = .808). Operative time exhibited a significant downward trend (P < .001), with the median operative time dropping from 150 minutes for the first 10 implants to 134 minutes for the subsequent 10 implants. The decrease in AHI from baseline to 12-month follow-up was equivalent between the first and second ten (22.8 vs 21.2 events/hour, respectively, P < .001). Similarly, the first and second ten groups had equivalent ESS decreases at 6 months (2.0 vs 2.0, respectively, P < .001). ESS outcomes remained equivalent for those with data through 12-months. Across the centers' first 20 implants, an approximately 11% reduction operative time was identified, however, no learning curve effect was seen for 6-month or 12-month AHI or ESS over the first twenty implants. Ongoing monitoring through the ADHERE registry will help measure the impact of evolving provider and patient specific characteristics as the number of implant centers increases.

0637 Comparison of AHI and ESS Outcomes Between Patients with Obstructive Sleep Apnea Undergoing Sleep Surgery versus Upper Airway Stimulation

Abstract Introduction Single or multi-level soft tissue surgical interventions are common options for CPAP-intolerant patients with OSA. Upper Airway Stimulation (UAS) is an alternative option using an implantable hypoglossal nerve stimulator. We compared patient outcomes between traditional sleep surgery (TSS) and UAS. Methods We selected patients who underwent TSS (including palate, oropharynx, tongue, and/or epiglottis-based procedures) for OSA and also met general UAS criteria (BMI≤35, AHI between 15-65, absence of palate concentric collapse during DISE, if available) for chart review. UAS outcomes were collected from the ADHERE international registry. For both groups, post-op AHI was collected, including full-night UAS efficacy studies. Data are presented as mean and standard deviation. Results The TSS group (n=284) and UAS group (n=541) were predominantly male and overweight. The TSS group was younger than UAS (47±12 vs 60±11 years, p&amp;lt;0.001). At baseline, both groups had severe OSA with AHI of 34±14 and 36±15 (p=0.23) and excessive daytime sleepiness with ESS of 12±5 and 12±6, (p=0.38), respectively. TSS follow-up was 169±151 days vs 392±181 days for UAS, which was significantly different. UAS had significantly larger decrease in AHI than TSS (-21/h±18 vs -16/h±16, p&amp;lt;0.0001). Both groups had a large decrease in ESS, however, the UAS group had a slightly smaller decrease, (-6±5 vs -5±5, p=0.01). Using the Sher response criteria of 50% AHI reduction and ≤ 20 events/hour, UAS had a 70% response rate vs 51% for TSS. Conclusion This study represents largest and first international, multicenter comparison of UAS to traditional surgical interventions for OSA, albeit with limitations of potential differential patient selection. While both TSS and UAS show similar improvement in symptoms, upper airway stimulation has a larger reduction of AHI with higher rates of therapy response than traditional sleep surgery Support ADHERE data assistance from Inspire Medical (Minneapolis, MN)

0902 The Use Of Auto-titrating Continuous Positive Airway Pressure (auto Cpap) For Obstructive Sleep Apnea In Children With Neurological Disorder

Abstract Introduction Multiple studies have demonstrated the effectiveness of auto-titrating continuous positive airway pressure (auto CPAP) in the adult population, but there is limited literature on the use of auto CPAP in the pediatric population. Specifically, the use of auto CPAP in children with neurological disorder(s) has not been established. Thus, we conducted a study to review the use of auto CPAP in children ages 18 years old and younger with Obstructive Sleep Apnea Syndrome (OSAS) and associated neurological disorder to document its effectiveness, adverse events and outcomes of its use. Methods A retrospective chart review was performed on patients 18 yo and younger diagnosed with OSAS and associated neurological disorder(s) who have good compliance with auto CPAP use. Good compliance was defined as &amp;gt;4 hours/night and &amp;gt;20/30 days of auto CPAP use. Compliance from the most recent 30 days was downloaded. Results 5 children met our criteria for inclusion, with a mean age of 11 years (6-18 years old). All had initial baseline sleep studies performed without PAP titration polysomnography. Associated neurological disorders were cerebral palsy, Arnold Chiari Malformation, seizure disorder and intellectual disability. The average length of use of auto CPAP was 4 months. Auto CPAP was used on average of 24/30 nights, with a mean of 7.35 hours/night. The mean baseline obstructive apnea-hypopnea (OAHI) index was 42 (8.2-94.4). The mean AHI on a 30 day download report showed a mean decrease in AHI to 2.9 (0.5-5.2) while on auto CPAP. Review of patient charts did not reveal any adverse outcomes associated with the use of auto CPAP in these patients. Conclusion This study showed that auto CPAP significantly improved the AHI in pediatric patients treated for OSA with associated neurological disorder. There were no reported adverse outcomes. Further research is needed to establish the effectiveness and safety of auto CPAP use in the pediatric population, specifically those with neurological disorder. The use of auto CPAP will help decrease the wait time for treatment in children with OSA. These patients can use auto CPAP while waiting for a titration study and for long term use. Support none

Robo-Cob technique; transoral endoscopic coblation tongue base resection in obstructive sleep apnea patients.

Another transoral tongue base surgical procedure for obstructive sleep apnea (OSA) is described. The procedure was named as the "Robo-Cob" technique because it is similar to transoral robotic surgery (TORS) but using a coblation technology to manage tongue base hypertrophy in patients with OSA especially in countries where TORS is not an available option for such benign conditions. The technique is described step by step. The new surgical technique was carried out in 25 adult OSA patients with mean age of 41.36 ± 8.72years (average 23-56) with confirmed tongue base hypertrophy by preoperative drug-induced sleep endoscopy (DISE). Coblation was used to resect, not ablate, the tongue base with similar technique as described in TORS. The Robo-Cob technique is proved to be feasible and effective in all cases either alone or when combined with other procedures in multilevel surgery settings. There were no significant intraoperative or postoperative complications. No tracheostomy was done in any patient. Objective clinical improvement was confirmed by polysomnography 3months postoperatively with significant decrease in mean AHI from 33.84 ± 10.54 to 11.52 ± 5.42 (P< 0.005). Moreover, this technique provided tongue base tissue specimen that allowed measurement of its volume that ranged from 10 to 22cc (mean 14.96 ± 3.62cc) to monitor extent of tissue resection. The added value of using coblation in resection, not ablation, is being quicker, and being able to provide tissue specimen to measure its volume to judge resection limits.

Maxillomandibular Advancement for the Treatment of Obstructive Sleep Apnea in Patients With Normal or Class I Malocclusion.

Maxillomandibular advancement is an effective surgical option for obstructive sleep apnea (OSA) that achieves enlargement of the upper airway by physically expanding the facial skeleton. The authors sought to determine whether an advancement of 10 mm predicts surgical success and if any correlation existed between the magnitude of mandibular/maxillary advancement and improvement in polysomnography metrics using aggregated individual patient data from multiple studies. A search of the PubMed database was performed to identify relevant articles that included preoperative and postoperative polysomnography data and measurements of the advancement of both the maxillary and mandibular portions of the face in patients with normal or class I malocclusion. Each patient was stratified into "Success" or "Failure" groups based on criteria defining a "Success" as a 50% preoperative to post-operative decrease in AHI or RDI and a post-operative AHI or RDI <20. A review of the PubMed database yielded 162 articles. Review of these resulted in 9 manuscripts and a total of 109 patients who met the inclusion criteria. There was no statistically significant difference in the amount of anterior advancement of either the mandible (P = 0.96) or the maxilla (P = 0.23) between the "Success" or "Failure" groups. While there is a paucity of individual data available, the current data does not support an ideal amount of maxillary or mandibular advancement that is required to obtain a surgical success in the treatment of OSA. Until a multicenter, prospective, randomized trial is performed, surgical planning should be tailored to patient-specific anatomy to achieve the desired result.

Effects of an individualized exercise training program on severity markers of obstructive sleep apnea syndrome: a randomised controlled trial

ObjectiveObstructive sleep apnea (OSA) is a high prevalent disorder with severe consequences including sleepiness, metabolic, and cardiovascular disorders. The aim of this study was to assess the effect of an individualized exercise-training (IET) program with educational sessions vs educational sessions alone on severity markers of OSA over an eight-week duration. MethodsThis was a randomised, controlled, parallel-design study. In sum, 64 patients with moderate-to-severe OSA (apnea-hypopnea index AHI 15–45/hour), low physical activity level (Voorrips<9), body-mass index (BMI) <40 kg/m2 were included in intervention group (IG) or control group (CG), and 54 patients finished the study. All underwent polysomnography (PSG), multiple sleep latency test (MSLT), constant workload exercise test, blood samples and fulfilled questionnaires twice. The primary endpoint was the change in apnea-hypopnea (AHI) at eight weeks from baseline. Main secondary endpoints were daytime sleepiness assessed by questionnaire and objective tests. ResultsNo significant between-group differences were found for changes in AHI. A reduction in AHI was found in IG only (p = 0.005). Compared to CG, exercise training leads to a greater decrease in AHI during REM sleep (p = 0.0004), with a significant increase in mean daytime sleep latency (p = 0.02). Between-group differences were significant for weight reduction, severity of fatigue, insomnia and depressive symptoms with trend for sleepiness symptoms. ConclusionsIn adult patients with moderate-to-severe OSA, IET did not decrease AHI compared to the control group but improved markers of severity of OSA, in particular AHI in rapid eye movement (REM) sleep and objective daytime sleepiness. Adding personalized exercise training to the management of patients with OSA should be considered. ClinicalTrials.gov identifierNCT01256307.

Efficacy and tolerability of a custom-made Narval mandibular repositioning device for the treatment of obstructive sleep apnea: ORCADES study 2-year follow-up data

Objective/backgroundMandibular repositioning device (MRD) therapy is an alternative to continuous positive airway pressure (CPAP). The Orkney Complex Disease Study-ORCADES study is assessing the long-term efficacy and tolerability of MRD therapy in obstructive sleep apnoea syndrome (OSAS); two-year follow-up data are presented. Patients/methodsOSAS patients who refused or were noncompliant with CPAP were fitted with a custom-made computer-aided design/computer-aided manufacturing (CAD/CAM) bi-block MRD (ResMed, Narval CC™); mandibular advancement was individually titrated. Sleep and respiratory parameters were determined at baseline, 3–6 months, and two years. The primary endpoint was treatment success (percentage of patients achieving a ≥50% reduction in the apnoea-hypopnoea index [AHI]). ResultsOf 315 enrolled patients, 237 remained on MRD treatment at two years, and 197 had follow-up data. The treatment success rate at two years was 67%; AHI <5/h, <10/h and <15/h was achieved in 30%, 56% and 72% of patients, respectively. On multivariate analysis, ≥50% decrease in AHI at 3–6 months and absence of nocturia at 3–6 months were significant predictors of MRD treatment continuation. Adverse events were generally mild, and the majority occurred in the first year of treatment. ConclusionsTwo years' treatment with an MRD was effective and well tolerated in patients with mild to severe OSAS who refused or were intolerant of CPAP.

Outcomes of Children with Mild Obstructive Sleep Apnea Treated Nonsurgically: A Retrospective Review

Obstructive sleep apnea (OSA) is characterized by partial or complete obstruction of the upper airway and is commonly caused by adenotonsillar hypertrophy in children. Accordingly, adenotonsillectomy is considered first-line treatment. However, in cases of mild OSA, nonsurgical management has been proposed as an alternative. The purpose of this study was to determine the outcomes of pediatric patients with mild obstructive sleep apnea (OSA) treated without surgical intervention. Case series with chart review. Tertiary care university medical center. The medical records of children ages 2 to 18 years with OSA at Boston Medical Center from January 2000 to April 2017 were reviewed. Children with mild OSA (apnea- hypopnea index [AHI] between 1 and 5), who were managed nonsurgically and had serial polysomnograms, were included. Serial sleep studies were compared to assess for patterns of change. Of the 201 patients with mild OSA who were identified, 104 (52%) opted for initial nonsurgical management. Of those, 91 had a follow-up sleep study to reassess their OSA. Forty-two (46 %) had a greater than 20% decrease in AHI and 38 (41%) had a greater than 20% increase on the second sleep study. The remaining 11 had changes less than 20% in either direction. There was not a significant difference in the proportion of patients with an increase vs decrease in AHI on follow-up sleep study ( P > .05). Mild pediatric OSA has approximately equal chances of worsening or improvement over time without surgical intervention, which is useful for counseling parents on treatment options.

Sleep quality in survivors of critical illness.

There is limited data regarding the sleep quality in survivors of critical illness, while the time course of the sleep abnormalities observed after ICU discharge is not known. The aim of this study was to assess sleep quality and the time course of sleep abnormalities in survivors of critical illness. Eligible survivors of critical illness without hypercapnia and hypoxemia were evaluated within 10days (1st evaluation, n = 36) and at 6months after hospital discharge (2nd evaluation, n = 29). At each visit, all patients underwent an overnight full polysomnography and completed health-related quality of life questionnaires (HRQL). Lung function and electro-diagnostic tests (ED) were performed in 24 and 11 patients, respectively. At 1st evaluation, sleep quality and HRQL were poor. Sleep was characterised by high percentages of N1, low of N3 and REM stages, and high apnea-hypopnea index (AHI, events/h). Twenty-two out of 36 patients (61%) exhibited AHI ≥ 15 (21 obstructive, 1 central). None of the patients' characteristics, including HRQL and lung function, predicted the occurrence of AHI ≥ 15. At 6 months, although sleep quality remained poor (high percentages of N1 and low of REM), sleep architecture had improved as indicated by the significant increase in N3 [4.2% (0-12.5) vs. 9.8% (3.0-20.4)] and decrease in AHI [21.5 (6.5-29.4) vs. 12.8 (4.7-20.4)]. HRQL improved slightly but significantly at 6months. Neither the changes in HRQL nor in lung function tests were related to these of sleep architecture. Six out of eight patients with abnormal ED at 1st evaluation continued to exhibit abnormal results at 6months. Survivors of critical illness exhibited a high prevalence of obstructive sleep-disordered breathing and poor sleep architecture at hospital discharge, which slightly improved 6months later, indicating that reversible factors are partly responsible for these abnormalities.

Palate surgery for obstructive sleep apnea: a 17-year meta-analysis.

Systematic review of palate surgery for the treatment of OSA. Independent searches to identify publications relevant to OSA treatment and upper airway palate surgery. All relevant studies published between January 2001 and February 2018 were included. Inclusion criteria were adult patients, documented airway evaluation methods and absent hypopharyngeal collapse. Outcomes included success rates of treatment, AHI, Epworth scale, QOL and snoring VAS. Fifty-nine papers with a total of 2715 patients, UPPP accounted for 16.7% of all the procedures. Evident differentiation progressing from 2001 to 2018, from 2001 to 2010, the percentage of UPPP procedures were 25.67%, from 2011 to 2018, there were only 12.6% of UPPP procedures. The average follow up was 8.18months. Meta-analysis on the AHI change for all procedures, showed the fixed effect AHI per follow-up (FU) month change was 1.45 (95% CI 1.33, 1.8), p < 0.001; while for ESS, the fixed effect AHI per FU month change was 0.61 (95% CI 0.56, 0.66), p < 0.001. The mean decrease in AHI was from 35.66 to 13.91 (p < 0.001). The mean decrease in ESS was from 11.65 to 5.08 (p < 0.001). The mean AHI change was 19.9 (p < 0.001). The mean ESS change was 5.8 (p < 0.001). The overall pooled success rate was 67.5%. Meta-analysis of the procedures, showed that the respective mean AHI reduction was 24.7 for the anterior palatoplasty (p = 0.015), 19.8 for the lateral/expansion pharyngoplasty (p = 0.046), and 17.2 for the uvulopalatopharyngoplasty (p = 0.360). Better understanding of the upper airway and objective airway evaluation diagnostic techniques and innovative palate surgeries have improved success rates of OSA surgery.

Polysomnography outcomes on patients with obstructive sleep apnea after upper airways repermeabilization surgery

Abstract BACKGROUND. Sleep apnea is a pathology with an ever-increasing spread, the causes being the most diverse. In this study we focus on sleep breathing disorders caused by nasal obstruction and also by soft palate and uvula anatomical changes. The right treatment recommended in this pathology according to the American Academy Sleep Medicine (AASM) is non-invasive ventilation – positive airway pressure (CPAP). A substantial percentage of patients with obstructive sleep apnea seek alternatives to CPAP and the solution for this can be upper airway surgery. OBJECTIVE. The attempt to demonstrate the viability of upper respiratory tract surgery as an alternative to CPAP treatment, demonstrating objectives by pre- and postoperative polysomnographic control. RESULTS. Aggregating the data from all 54 patients with nasal obstruction and pharyngeal modifications, we observed a decrease in AHI from 20.406/h to 15.86/h, representing 32.36%, an improvement in sleep architecture and especially REM sleep from 41.5 minutes initially to 67.8 minutes (increased value with 63.37 percent). CONCLUSION. The benefits of nasopharyngeal repermeabilization surgery are represented by decreasing the severity of respiratory events and, second to this, lowering the number of arousals. By reducing the number of arousals, one will obtain a better percentage regarding the deep sleep phase - REM, having a beneficial effect on reducing the daytime sleepiness – which is a major symptom that patients are present.

Different Strategies to Treat Paroxysmal AF in Patients with Moderate CKD and Severe OSA: a sub group Analysis

Accentuated sympathetic nerve activity is a strong danger feature for cardiovascular major episodes, such as cerebral and myocardial ischemia/infarction. Peripheric sympathetic nerve activity is emphasized in the hypertensive state, congestive cardiac failure, OSA, heaviness, diabetes, and chronic kidney disease (CKD) subjects. Leastwise a half of individuals with hypertension present augmented sympathetic nerve activity. Our group believes that RSD can reduce AF recurrence in patients with CKD and OSA by modulation of the sympathetic hyperactivity present in these diseases. The goal of this prospective study was to compare the impact of different treatments including CPAP, PVI, RSD, and some combination of them in controlled hypertensive patients with paroxysmal AF, moderate CKD, and severe OSA. Our data suggest that the patients underwent RSD associated to CPAP treatment or PVI, or both of them presented an improvement in the renal function, a decrease in AHI and a lower chance to present AF recurrence than the ones that did not suffer this intervention. Although encouraging, our data are preliminary and need long-term validation in a large population.

Very Severe Obstructive Sleep Apnea in Children: Outcomes of Adenotonsillectomy and Risk Factors for Persistence.

Objectives (1) To describe the clinical, demographic and polysomnographic (PSG) characteristics of children with very severe obstructive sleep apnea (OSA) without significant comorbidities; (2) to assess the outcomes following tonsillectomy and adenoidectomy (T&A); and (3) to determine predictors of persistence of OSA after T&A. Study Design Case series with chart review. Setting Tertiary-level freestanding children's hospital. Subjects and Methods Seventy-four children aged 2 to 12 years who underwent T&A for very severe OSA (obstructive apnea-hypopnea index [AHI] >30) were included. Children with significant comorbidities were excluded. PSG variables were compared pre- and post-T&A using statistical tests. Factors affecting OSA resolution and persistence were studied. Results The mean (95% confidence interval) age was 4.3 (3.8-4.7) years with the majority black or Hispanic (64/74, 86%). The mean decrease in AHI after T&A was 49 (43-58) ( P < .001). Complete resolution of OSA, defined by an AHI <1, or an AHI <5 was seen in 32% (24/74) and 80% (59/74), respectively. Total sleep time (TST) greater than 5 minutes with end-tidal CO2 >50 mm Hg was strongly associated with persistent OSA. The decrease in AHI post-T&A was best predicted by higher preoperative oxygen saturation (SpO2) nadir and lower TST with SpO2 <90% ( R2 = 0.24, P < .001). Conclusions T&A is associated with a significant improvement but not resolution of very severe OSA. The severity of baseline hypercapnia and hypoxemia may best predict persistent OSA after T&A. The study supports obtaining routine post-T&A PSG in children with very severe OSA.