Postoperative Polysomnography Research Articles

Impacts of mandibular setback with or without maxillary advancement for class III skeletal correction on sleep-related respiratory parameters: A systematic review and meta-analysis.

A systematic review and meta-analysis was conducted to evaluate the impacts of mandibular setback with or without maxillary advancement for class III skeletal correction on respiratory parameters measured by polysomnography (PSG) and to compare these respiratory parameters between these procedures for class III skeletal correction. Six electronic databases were searched up to June 2023. Studies comparing PSG parameters before and after orthognathic surgery for skeletal class III patients were selected for further analysis. The outcomes of interest were apnoea-hypopnea index (AHI), respiratory disturbance index (RDI), the lowest oxygen saturation (lowest SpO2), the average oxygen saturation (mean SpO2), and the 3% oxygen desaturation index (3% ODI). Data extraction, methodological quality assessment, risk of bias assessment, meta-analysis, and subgroup analysis were performed. Sixteen studies with a total of 476 patients who underwent orthognathic surgery for class III skeletal correction were included for meta-analysis. The risk of bias level was moderate for most studies. All PSG parameters before and after orthognathic surgery were not significantly different. The different surgical procedures also did not significantly affect post-operative PSG parameters. 5.8% of patients developed post-operative obstructive sleep apnoea (OSA). Most of them underwent a large distance of mandibular setback. There is a moderate level of evidence that mandibular setback with or without maxillary advancement for class III skeletal correction does not pre-dispose young and healthy patients to obstructive sleep apnoea when evaluated in the short term after surgery. However, post-operatively developed OSA was found in several isolated cases that underwent a large amount of mandibular setback with or without maxillary advancement.

Predictors of surgical outcomes for limited palatal muscle resection in patients with obstructive sleep apnea

ObjectiveLimited palatal muscle resection (LPMR) is a modified palatal surgical technique to correct retropalatal obstruction without complications. This study aims to determine the associated factors affecting the success and cure rate of LPMR in patients with obstructive sleep apnea (OSA), thus guiding patient selection and improving surgical outcome. MethodsThirty-five OSA patients underwent LPMR were enrolled. All patients received routine physical examination, preoperative drug-induced sleep endoscopy (DISE), and polysomnography (PSG). Clinical, polysomnographic, cephalometric variables, and DISE findings were evaluated. These measurements were compared between the surgical success and failure group based on the results of preoperative and postoperative PSG. Furthermore, we compared the cured and non-cured groups in the surgical success group. ResultsAmong 35 patients, the overall success rate was 57 % with a cure rate of 31.4 %. Patients with Friedman stage II had a significantly higher success rate (p = 0.032). According to DISE results, tongue base obstruction affected the surgical outcome (p < 0.001). The success rate was 100 % in the no tongue base obstruction during DISE, 72.2 % in the partial obstruction, and 9.1 % in the total obstruction. Tonsil size is also helpful in predicting surgical success rate (p = 0.041). Furthermore, patients with mild AHI were more likely to be surgical cures. when compared with patients with severe AHI (p = 0.044). ConclusionPatients with larger tonsil size and no tongue base obstruction during DISE may have a higher chance of surgical success with LPMR. The lower AHI may be predictors of surgical cure after LPMR.

Safety and efficacy of lingual tonsillectomy in multilevel airway surgery for pediatric obstructive sleep apnea.

Prior studies have demonstrated the efficacy of lingual tonsillectomy in treating pediatric obstructive sleep apnea. The goal of this study is to describe the postoperative outcomes following lingual tonsillectomy as a part of drug-induced sleep endoscopy-directed multilevel sleep surgery. A retrospective review was performed for pediatric patients with obstructive sleep apnea who underwent lingual tonsillectomy as a part of drug-induced sleep endoscopy-directed sleep surgery. Data collected included age, sex assigned at birth, body mass index z-score, polysomnography results, past medical and surgical history, and postoperative outcomes. A total of 174 patients were included in the study with a mean age of 8.29 ± 3.49 years (range 1.89-15.62) and mean preoperative apnea-hypopnea index of 7.88 ± 13.42 (range 1.10-123.40). Complications occurred in 26 patients (14.9%) including 14 patients (8.0%) requiring emergency department visit or readmission and 12 patients (6.9%) experiencing postoperative bleeding. Asthma (P = .033) and developmental delay (P = .016) correlated with postoperative complications. For patients with preoperative and postoperative polysomnography data (n = 145; 83.3%), there was significant improvement (P < .001) in apnea-hypopnea index with a mean postoperative apnea-hypopnea index of 4.02 ± 7.81 (range 0.00-54.46). Surgical failure, defined as postoperative apnea-hypopnea index ≥ 5, was identified in 25 patients (17.2%). Surgical failure was associated with body mass index z-score > 2 (P = .025) and Trisomy 21 (P = .005). This study highlights the promising surgical success rate of drug-induced sleep endoscopy-directed lingual tonsillectomy in multilevel sleep surgery (82.8%) and infrequent complications including postoperative bleeding (6.9%) and readmission (2.3%). Williamson A, Morrow VR, Carr MM, Coutras SW. Safety and efficacy of lingual tonsillectomy in multilevel airway surgery for pediatric obstructive sleep apnea. J Clin Sleep Med. 2024;20(2):189-199.

Lost to follow-up: Post-operative polysomnography in at-risk, pediatric obstructive sleep apnea

Analyze adherence to AASM recommendations for post-operative polysomnography in eligible pediatric patients.Retrospective Cohort.Tertiary, Outpatient Sleep Lab.We conducted a retrospective analysis of pediatric patients, ages 1-17, previously diagnosed with moderate-severe obstructive sleep apnea that completed a surgical intervention. Chart review included demographic data, a co-morbidity of interest, the presence of an otolaryngology, primary care, or sleep medicine encounter, time to follow-up, the presence of a post-operative polysomnography, time to post-operative polysomnography, and the presence of an annual follow-up with any provider.Of the 373 patients, 67 patients met inclusion criteria. Fifty-nine followed-up with any provider, with 21 completing post-operative polysomnography. Patients with residual or recurrent symptoms (p < 0.01) and all patients with severe obstructive sleep apnea (p = 0.04) were more likely to complete post-operative polysomnography (PSG). Sub-analysis across at-risk categories (isolated moderate, isolated severe, moderate & a co-morbidity, and severe & a co-morbidity) revealed patients with severe obstructive sleep apnea & a co-morbidity completed a follow-up PSG more often than isolated moderate obstructive sleep apnea (p = 0.01). There was a difference in follow-up with sleep medicine across at-risk categories (p < 0.01).Recurrent symptoms and increasing disease severity were associated with obtaining post-operative polysomnography. However, variability existed for which patients completed post-operative polysomnography. We speculate an inconsistent standard across disciplines, inadequate post-operative obstructive sleep apnea management education, and uncoordinated systemic processes contribute to this discrepancy. Our findings support a standardized, multi-disciplinary care pathway for the management of at-risk, pediatric obstructive sleep apnea.

SP27. Mandibular Distraction in Patients with Pierre Robin Sequence: A Multi-surgeon Experience

PURPOSE: Mandibular distraction osteogenesis (MDO) is rapidly becoming a standard of care for management of patients with severe Pierre Robin Sequence. The tongue is brought forward to alleviate the airway obstruction. This study will look at an institutional, multi-surgeon experience with MDO over ten years. METHODS: This study was conducted as a retrospective chart review including all patients who underwent MDO at the authors’ institution from 2012 to 2022. Demographics, preoperative and postoperative respiratory and feeding status, and distraction data were collected. Primary outcomes were achievement of full oral feeds, avoidance of a gastrostomy tube (GT), avoidance of a tracheostomy, discharge from hospital on room air and complications. A significance value of 0.05 was utilized. RESULTS: Twenty-eight patients met inclusion criteria. Three craniofacial surgeons performed all interventions. The average age at MDO was 135 days, mean activation phase was 13.6 days, mean distraction length was 14.9 mm and mean consolidation phase was 64.2 days. MDO showed a significant improvement in apnea-hypopnea index (AHI) (p < 0.001) and %O2 Nadir (p < 0.001) on postoperative polysomnography. Syndromic patients were associated with discharge with a GT and negatively associated with avoidance of tracheostomy. Patients with preoperatively diagnosed tracheomalacia and subglottic stenosis were negatively associated with avoidance of a tracheostomy. Preoperative diagnosis of gastroesophageal reflux disease (GERD) was negatively associated with extubation immediately to room air (RA) following index procedure. A shorter duration of intubation following index procedure was associated with discharge on RA and a longer duration of intubation was associated with unilateral pan-facial nerve palsy. A longer activation phase was associated with discharge with a GT and a shorter activation phase was associated with discharge on full oral feeds. The ability to discharge on RA was associated with a shorter latency phase, shorter activation phase, and decreased distance of distraction. Repeat MDO was associated with postoperative infection requiring operative management. CONCLUSIONS: The goal of MDO is to achieve full oral feeds with no respiratory support. Several interesting findings are described in this study. When assessing patients preoperatively it is important to note the higher rate of failure to avoid a tracheostomy in patients with a syndrome and those with tracheomalacia and subglottic stenosis noted on airway evaluation. Syndromic patients were also noted to be more likely to be discharged with a GT. Several different latency periods were used in this study, and it appears that not only is a short latency period safe, but that it may be correlated with successful discharge on RA. This should be tempered with the finding that a decreased time spent intubated following surgery, decreased distance distracted and time spent in activation was also associated with discharge on RA, which may be a function of the severity of micrognathia in these patients. Of note, patients that spent a longer period intubated following surgery experienced a higher rate of facial nerve palsy. The reason for this correlation is unclear but may represent more severe cases that resulted in more forced retraction during surgery.

Bariatric surgery and obstructive sleep apnea: a systematic review and meta-analysis.

Several studies evaluated the effect of bariatric surgery on obstructive sleep apnea (OSA) but findings have been inconsistent. The aim of this study was to conduct an updated systematic review and meta-analysis to investigate the effect of bariatric surgery on OSA. The databases for PubMed, CENTRAL, and Scopuswere searched up to the 1st of December, 2021. Studies were included if they were cohort or case-control in design, included patients with diagnosisof OSA, the patients underwent any bariatric surgery, and the study performed postoperative polysomnography. The total number of the included patients was 2310 patientswith OSA from 32 studies. Our analysis showed that bariatric surgery was associated with significant reduction in BMI (WMD = - 11.9, 95%CI: - 13.4, - 10.4), apnea-hypopnea index (AHI) (WMD = - 19.3, 95%CI: - 23.9, - 14.6), and respiratory disturbance index (RDI) (WMD = - 33.9, 95%CI: - 42.1, - 25.7). The rate of OSA remission after the surgery was 65% (95%CI: 0.54, 0.76). Our results suggest that bariatric surgeries are effective in reducing obesity among patients withOSA in addition to OSA severity measures. However, the low rate of OSA remission suggests that the main etiology of OSA is not only obesity but also includes other important variables such as the anatomy of the jaw.

Demographic factors associated with postoperative polysomnography for pediatric patients with persistent obstructive sleep apnea

Demographic factors associated with postoperative polysomnography for pediatric patients with persistent obstructive sleep apnea

Supine Pharyngeal Width Is Associated With Complete Concentric Palatal Collapse During Drug-Induced Sleep Endoscopy and Hypoglossal Nerve Stimulator Outcomes.

Hypoglossal nerve stimulation (HNS) implantation in the US requires preoperative drug-induced sleep endoscopy (DISE) screening for complete concentric palatal collapse (CCC) to establish treatment candidacy. We hypothesized that supine pharyngeal width (SPW) in awake patients is associated with CCC and HNS therapy outcomes. Adults with moderate to severe obstructive sleep apnea underwent awake measurement of SPW followed by DISE screening for CCC. Eligible patients electing for HNS implantation underwent postoperative polysomnography per standard of care. SPW was measured in 73 patients. For SPW >20mm, the positive likelihood ratio for absence of CCC was 6.67 with pre- and post-test odds of 6.3 and 42.0, respectively. Postoperative PSG data were available from 31 of 44 (70.5%) patients subsequently implanted with HNS. Patients with SPW >20mm had a greater rate of HNS response than those with SPW ≤20 (62 vs 30%; P < .05). Only SPW and BMI were significantly associated with CCC and HNS response in regression models. In a retrospective cohort study, SPW was significantly associated with CCC and postoperative apnea-hypopnea index following HNS implantation. SPW may be a viable screening tool for HNS candidacy.

Tonsillectomy in Children with 22q11.2 Deletion Syndrome

Tonsillectomy is one of the most common procedures performed in children, however there are currently no published studies evaluating tonsillectomy in children with 22q11.2 deletion syndrome (22q11DS). With this study, our goal was to investigate the indications, efficacy, and complications of tonsillectomy in a pediatric cohort of patients with 22q11DS. This is a retrospective chart review of patients in our 22q Center's repository. Inclusion criteria were a diagnosis of 22q11DS and a history of tonsillectomy or adenotonsillectomy. Data collected included: indications for tonsillectomy, preoperative and postoperative polysomnography (PSG) results, and surgical complications. In total, 33 patients were included. Most common indications for tonsillectomy were facilitation with speech surgery (n = 21) and sleep-disordered breathing (SDB)/obstructive sleep apnea (OSA) (n = 16). Average length of stay was 1.15 days. Most patients (69%) had some degree of persistent OSA on postoperative PSG. Complications occurred in 18% of patients and included respiratory distress, hemorrhage, and hypocalcemia. This study demonstrates tonsillectomy was a commonly performed procedure in this cohort of patients with 22q11DS. These data highlight the potential need for close postoperative calcium and respiratory monitoring. The data were limited with respect to PSG outcomes, and future studies are needed to better characterize OSA outcomes and complications in this patient population.

Use of VOTE score in predicting outcomes in pediatric obstructive sleep apnea

Obstructive Sleep Apnea (OSA) affects 1-4% of the pediatric population in the U.S. Drug-Induced Sleep Endoscopy (DISE) is widely used to localize the level(s) of obstruction. The VOTE classification system is used to grade obstructions found at the velum, oropharynx, base of tongue, and epiglottis and has been validated in adults. This study aims to determine if the VOTE score has any predictive value in pediatric OSA postoperative outcomes. A retrospective chart review of 129 patients from January 7, 2016 to 05/30/2020 was performed. Included patients were between the ages of 2 and 17, undergoing DISE, and if they had preoperative and postoperative polysomnography (PSG) data. Excluded patients did not meet one of the above or had other comorbidities contributing to their sleep apnea. 53 patients were included. Pearson's Correlation tests compared intraoperative VOTE score to postoperative BMI, AHI, and O2 nadir and their relationships. We found a weakly positive correlation between the VOTE and postoperative AHI with a coefficient of 0.35 and a p-value of 0.01. We found a relationship between postoperative O2 nadir and AHI, with a coefficient of -0.627 and a p-value <0.0001. Finally, a paired, two-tailed t-test compared the mean change between preoperative and postoperative BMIs (+1.6), oAHIs (-23.5), and O2 nadirs (+14), all with p-value <0.0001. We demonstrated a correlation between VOTE and improved postoperative AHI and a relationship between improved postoperative AHI and postoperative O2 nadir. The validity of VOTE may be proven with larger sample size. Alternatively, a different scoring system may be required for pediatric OSA.

Therapeutic Effect of Extended Uvulopalatal Flap Surgery in Patients With Obstructive Sleep Apnea

Background and Objective Although numerous studies have reported surgical results of uvulopalatopharyngoplasty, efficacies of extended uvulopalatal flap (EUPF) surgery have only been reported in a few studies. Thus, the aim of this study was to evaluate the success rate of EUPF and investigate the advantage and practicality of this surgery.Methods Medical records of patients who underwent EUPF surgery were retrospectively analyzed. Through medical record analysis, demographic information was confirmed. Postoperative polysomnography (PSG) results were divided into a surgical ‘success’ group and a ‘failure’ group. Patients’ PSG results, questionnaires, and cephalometry were comparatively analyzed.Results All sleep parameters of PSG except rapid eye movement latency and hypopnea index were significantly improved after surgery. Ten patients were in the success group (success rate, 33.3%) and 20 patients were in the failure group. Among preoperative PSG parameters, apnea-hypopnea index, apnea index, and number of awakenings showed significant differences between the two groups. However, there were no significant differences in results of cephalometry or Friedman stage between the two groups.Conclusions The EUPF surgery can change sleep factors and improve subjective symptoms in obstructive sleep apnea patients. It could be considered as one of the treatment options for patients with surgical indications, although its success rate was only 33.3%.

Completion of postoperative polysomnography for children with severe obstructive sleep apnea: A quality improvement project.

ObjectivePediatric patients with severe obstructive sleep apnea (OSA) are at risk for residual OSA following tonsillectomy with/without adenoidectomy (T ± A). We initiated a quality improvement (QI) project to increase the percentage of postoperative (postop) polysomnography (PSG) completion to identify residual OSA.MethodsThis is a prospective QI project carried out at a tertiary pediatric academic hospital. Children ≤18 years of age who underwent T ± A for severe OSA were included. Our Specific, Measurable, Attainable, Relevant, and Time‐based (SMART) aim was to increase the percentage of completed postop PSGs in this cohort from a baseline of 70% to95% by May 31, 2021. We focused on patient education and leveraged both clinical decision support and reporting functionalities of the electronic medical record for project implementation.ResultsDuring the pre‐intervention period between January 1, 2019 to June 30, 2020, 472 patients met the inclusion criteria with an average age of 8.6 years (SD 4.6). The rate of postop PSG completion was 69.7% (SD 11.4%) with an average time of 99 days (SD 66) between surgery and the postop PSG. A shift was observed starting in September 2020, and the PSG completion rate improved to 94.9% by September 30, 2021. Post‐intervention, there were 178 patients with an average age of 9.3 years (SD 4.9). The average time between surgery and the postop PSG was significantly reduced to 57 days (SD 16; p < .001).ConclusionsThrough a multidisciplinary approach, we successfully completed our SMART aim. With the establishment of QI infrastructure, our goal is to deliver better care in a sustainable fashion using QI methodology.

Palatopharyngeal muscle suspension suture technique for patients with obstructive sleep apnea

PurposePalatal surgery remains a major option for patients with obstructive sleep apnea (OSA). We sought to evaluate the therapeutic outcomes of the palatopharyngeal muscle suspension suture technique (PSST) as a novel palatal surgery for patients with OSA. Materials and methodsOf the 816 patients who underwent polysomnography (PSG) from February 1, 2017, to June 30, 2020, 30 patients with OSA who underwent PSST were retrospectively reviewed. The medical records of the patients were also recorded. Among the 30 patients with OSA, nine who underwent preoperative and postoperative PSG were analyzed. ResultsOf the 30 patients with OSA, 28 (93.3 %) were male. The mean (SD, standard deviation) age was 43.3 (12.7) years, and the mean (SD) body mass index was 27.3 (3.2). As objective parameters, the mean (SD) apnea-hypopnea index was significantly decreased from 45.9 (21.20) to 29.03 (21.62) (p < 0.05) and the mean (SD) lowest oxygen saturation improved significantly from 77.6 % (7.14 %) to 84.6 (5.17 %) (p < 0.05). As a subjective parameter, the mean (SD) Epworth Sleepiness Scale score decreased significantly from 10 (4.95) to 6.9 (4.57) (p < 0.05), and the mean (SD) visual analog scale score for snoring decreased significantly from 6.3 (1.8) to 3.1 (1.9) (p < 0.001). No complications, such as upper airway obstruction, intractable postoperative bleeding, or velopharyngeal insufficiency, were observed in any of the patients postoperatively. ConclusionsA novel palatal surgery, PSST, has numerous advantages as a useful surgical option for patients with OSA. It is minimally invasive, easy, time-saving, and relatively reversible.

0839 Complex Sleep Apnea Improved with Decompression of a Chiari I Malformation in a Pediatric Patient

Abstract Introduction Chiari malformation (CM) occurs when a portion of the cerebellum herniates through the foramen magnum. CM is categorized as two types. Type 1 involves the cerebellar tonsils and type 2 involves the cerebellum and brain stem. Those with CM can be asymptomatic to having debilitating neurologic symptoms such as dysphagia, tinnitus, emesis, balance difficulty, muscle weakness, and/or headache. Central sleep apnea (CSA) and obstructive sleep apnea (OSA) have been associated with CM. It is postulated that the sleep disordered breathing (SDB) is due to compression of the medulla which houses the breathing center and cranial nerves that play a role in nocturnal breathing. OSA has been thought to be related to muscle weakness of the lower airway in those with CM. After resolving CM with surgical decompression, residual OSA is common requiring treatment with positive airway pressure therapy. Report of Cases: A 3-year-old male with a history of OSA and tonsillar hypertrophy. Polysomnography (PSG) was performed after tonsillectomy and adenoidectomy indicating severe OSA (oAHI 17.7/hr) and CSA (CSAI 29.9/hr). A titration study was conducted and bilevel positive airway pressure spontaneous/timed (BPAP ST) 10/6 cmH2O with a backup rate of 12 breaths per minute was utilized further resolving his SDB and daytime sleepiness. After months of BPAP ST therapy, he presented to an urgent care with symptoms of somnolence, emesis, and nystagmus of the left eye. Magnetic resonance imaging of the brain revealed a 2 cm herniation of the cerebellar tonsils indicating CM type 1. Neurosurgery performed surgical decompression without complication. Post-operative PSG indicated significant improvement of OSA (oAHI of 3.45/hr) and resolution of CSA (0.9/hr). BPAP ST therapy was discontinued with the resolution of his daytime sleepiness and SDB. Conclusion This case demonstrates a patient with severe OSA and CSA due to an undiagnosed CM type 1. OSA and CSA are associated with CM; however, residual OSA typically exists status post decompression and can require positive airway pressure therapy for treatment. Our case demonstrates the need for consideration of CM in patients with complex sleep apnea and that surgical decompression can improve both OSA and CSA in these patients. Support (If Any)

Outcomes of Adenotonsillectomy for Obstructive Sleep Apnea in Children Under 3 Years of Age.

Objectives: To identify predictors of obstructive sleep apnea (OSA) after adenotonsillectomy (T&A) in children under 3years of age and to describe the characteristics of children with OSA under 3years of age undergoing T&A in an ethnically diverse population. Methods: We examined 87 children under 3years with T&A and pre- and post-operative polysomnography (PSG) between 8/2012 and 3/2020 at a large tertiary care hospital. Differences were compared for covariates including demographics, comorbidities, and respiratory parameters. Regression was used to identify predictors of persistent severe OSA. Significance was set at P < .05. Results: Of the 87 children in the study, 64 (74%) were male, 26 (30%) were obese, 34 (39%) were Hispanic, and 35 (40%) were Black. Most children (94%) had improvements in OSA severity as measured by the apnea-hypopnea index (AHI) after T&A, but 78% had persistent OSA (AHI ≥1) after surgery. Children with persistent mild, compared to moderate-severe OSA, were more likely to have gastroesophageal reflux disease (GERD) (50% versus 24%, P = .025), a craniofacial disorder (30% versus 10%, P = .025), Down syndrome (20% versus 5%, P = .031), or pre-operative severe OSA. Conclusions: This study of an ethnically diverse population found that T&A is an effective procedure at improving, but not resolving, OSA in children under 3years. Children with Down syndrome, craniofacial abnormalities, GERD, or pre-operative severe OSA who are under 3years old are at high risk for persistent OSA and may benefit from post-operative PSG. Future study should examine complications and long-term outcomes of T&A in this age group.

Pediatric sleep outcomes after endoscopy-directed simultaneous lingual tonsillectomy and epiglottopexy

BackgroundThe purpose of this study was to evaluate the efficacy of sleep endoscopy-directed simultaneous lingual tonsillectomy and epiglottopexy in patients with sleep disordered breathing (SDB), including polysomnography (PSG) and swallowing outcomes.MethodsA retrospective review was performed of all patients undergoing simultaneous lingual tonsillectomy and epiglottopexy over the study period. PSG objective measures were recorded pre- and postoperatively, along with demographic data, comorbidities, and descriptive data of swallowing dysfunction in the postoperative setting.ResultsA total of 24 patients met inclusion criteria for consideration, with 13 having valid pre- and postoperative PSG data. Successful surgery was achieved in 84.6% of patients, with no difference based on presence of medical comorbidities including Trisomy 21. Median reduction in obstructive apnea–hypopnea index (oAHI) with the procedure was 69.9%. Four patients (16.7%) had postoperative concern for dysphagia, but all objective swallowing evaluations were normal and no dietary modifications were necessary.ConclusionCombination lingual tonsillectomy and epiglottopexy in indicated patients has a high rate of success in this single-institutional study without new dysphagia in this population. These procedures are amenable to a combination surgery in appropriately selected patients determined by sleep state endoscopy in the setting of SDB evaluated with drug-induced sleep endoscopy.Graphical abstract

The outcome of managing sleep apnea in children with cerebral palsy

BackgroundObstructive sleep apnea (OSA) is not an uncommon finding in the pediatric age group patients with cerebral palsy (CP).ObjectiveWe aimed to evaluate the frequency of occurrence of OSA in children with CP and the most appropriate surgical procedures used in these patients.Study designA prospective study was carried out on 67 children with OSA, 36 of whom suffer from CP. The data included the presenting complaint, any coexisting illnesses, preoperative and postoperative polysomnography results, the primary surgical procedure performed, age at the time of surgery, number of postoperative hospitalization days in the ICU, and presence of postoperative respiratory disorders.ResultsIn all, 40 (59.7%) children underwent adenotonsillectomy for initial treatment of OSA. Our results reported that the clinical manifestations were more significant in the CP-affected children. We documented a significant decrease in the mean value of the apnea hypoxia index in all included children postoperatively. However, there was no significant difference in apnea hypoxia index postoperatively among children in both groups. Nine (17.4%) children had an adenoidectomy alone and 18 (26.86%) children had tonsillectomy alone as their initial procedure. Neither uvulopalatopharyngoplasty nor tracheostomy was performed as an initial procedure. The mean follow-up was set for 24 months. Eighty-six percent of these children have not required any further surgery. Of the six children who have undergone further surgery, one required a revision adenoidectomy, and two underwent a tonsillectomy and uvulectomy 2 months after the initial adenoidectomy. Four CP children later required a tracheotomy for severe hypoxia.ConclusionOSA is a more frequent occurrence in CP children as compared with their healthy counterparts. They ultimately had significant improvement in their clinical presentations postoperatively, thus improving their quality of life.

Changes in laryngopharyngeal reflux after uvulopalatopharyngoplasty for obstructive sleep apnea: An observational study.

PurposeTo estimate laryngopharyngeal reflux (LPR) changes after uvulopalatopharyngoplasty (UPPP) for obstructive sleep apnea (OSA) using the reflux symptom index (RSI) and reflux finding score (RFS) questionnaires.MethodsA total of 91 participants were recruited and divided into three groups: control (n = 27), OSA mild to moderate (n = 29), and OSA severe (n = 35) groups according to polysomnography. All participants completed the preoperative RSI, and underwent blinded evaluation on videolaryngoscopy using the RFS questionnaire. Thirty‐four OSA patients who underwent UPPP surgery completed postoperative polysomnography and questionnaires again after a 6‐month follow‐up.ResultsThe RSI score and RFS were higher in patients with OSA than in those without OSA. Patients with severe OSA also had a higher RSI score and RFS than those with mild to moderate OSA. Apnea and hypopnea index degree and percentage of recording time for <90% oxygen saturation showed positive correlation with LPR symptoms. But the lowest blood oxygen saturation during the recording time was negatively correlated with LPR symptoms. The mean RSI score and RFS before UPPP surgery were 15.88 ± 4.85 and 13.18 ± 4.80, after surgery decreasing to 9.53 ± 4.16 and 8.65 ± 4.87, respectively (P <.05). In 25 patients where surgery was successful, RSI scores, RFSs and individual RSI variables decreased after surgery.ConclusionsLPR symptoms are common among OSA patients, and the coexistence of OSA and LPR cannot be ignored. Successful UPPP surgery potentially reduces LPR symptoms and improves laryngoscopic signs by alleviating sleep respiratory disorders. Level of Evidence: 3.

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.

Supine or non-supine apnea; which can be treated better with expansion sphincter pharyngoplasty?

ObjectivesExpansion sphincter pharyngoplasty is a well-known palatal correction surgery applied for obstructive sleep apnea patients. Even though high success rates are reported, in some patients, the desired outcome cannot be achieved. Therefore, patient selection is crucial to avoid undesirable outcomes. In this study we present our results with expansion sphincter pharyngoplasty, and we aim to show the difference between supine and non-supine apnea in terms of their response to the surgery, in order to utilize position dependency for selection of surgical candidates. MethodsPre- and post-operative polysomnography results of patients who underwent expansion sphincter pharyngoplasty were analyzed retrospectively. Total AHI, supine AHI, non-supine AHI, supine/non-supine AHI ratio and surgical success values are compared. Results85 patients were included to the study. Mean AHI significantly decreased from 48.7 ± 27.99 to 26.37 ± 21.16 with the surgery. Surgical success rate was found to be 51.8%. Both supine and non-supine apnea decreased significantly with the surgery, but the decrease was significantly higher in non-supine apnea (20.6% to 39.1% respectively, p = 0.016). There was significant negative correlation between pre-operative supine to non-supine AHI ratio and the change in AHI, showing that supine dominant patients had less improvement with the surgery (r = 0.274, p = 0.01). ConclusionExpansion sphincter pharyngoplasty is an effective surgery which achieves significant improvement in AHI. Non-supine respiratory events respond better to the surgery than supine events.