Retropalatal Collapse Research Articles

Risk of dysphagia in a population of infants born pre-term: characteristic risk factors in a tertiary NICU

ObjectiveTo examine the prevalence and characteristics of dysphagia and suck-swallow-breath incoordination as phenotypes of oral feeding difficulties. MethodA cross-sectional study with secondary data collected consecutively over 2 years from October 2020 to October 2022 to measure the prevalence of swallowing and oral feeding difficulty in preterm infants using Flexible endoscopic evaluation of swallowing examination at the tertiary Integrated Dysphagia Clinic. ResultsThe prevalence of swallowing disorders was 25 % and the prevalence of suck-swallow-breath incoordination was 62.5 %. The significant risk factor that may show a possible correlation with oral feeding difficulty was mature post-menstrual age (p = 0.006) and longer length of stay (p = 0.004). The dominant percentage of upper airway abnormality and disorder were retropalatal collapse (40 %), laryngomalacia (42.5 %), paradoxical vocal cord movement (12.5 %), and gastroesophageal reflux disease (60 %). The dominant characteristic of oral motor examination and flexible endoscopic evaluation of swallowing examination was inadequate non-nutritive sucking (45 %), inadequate postural tone (35 %), and inadequate nutritive sucking (65 %). ConclusionDysphagia in preterm infants is mostly observed in those with mature post-menstrual age, longer length of stay, and the presence of gastroesophageal reflux disease with inadequate non-nutritive sucking and nutritive sucking abilities. Suck-swallow-breath incoordination is primarily observed in those with immature post-menstrual age, a higher prevalence of cardiopulmonary comorbidity, and a higher prevalence of upper airway pathologies (laryngomalacia, paradoxical vocal cord movement) with inadequate nutritive sucking ability.

Barbed palatal surgery: single stage or multilevel setting-a systematic review by the Young Otolaryngologists of the Italian Society of Otolaryngology.

This systematic review aims to compare the efficacy and safety of multilevel and single level surgery, including barbed pharyngoplasties, in the treatment of obstructive sleep apnea (OSA). The study followed PRISMA guidelines and searched PubMed/MEDLINE, Google Scholar, and Ovid databases for studies evaluating the effect of barbed pharyngoplasties on adults with OSA. Prospective and retrospective cohort studies were included with pre- and post-treatment comparisons of sleep tests and self-reported clinical outcomes. Exclusion criteria were non-English studies, case reports, reviews, conference abstracts, letters, and pediatric studies. Successful surgery was classified using Sher's criteria. The study selected a total of 1014 patients from 26 studies, 24 of which were longitudinal studies with 10 retrospective trials and 14 prospective studies. The average age of the patients was 46.9years, with an average Body Mass Index (BMI) of 25.6kg/m2. Most of the patients were male (84.6%). The study included only palatal surgical techniques with barbed sutures, and patients who underwent cardio-respiratory monitoring and Drug Induced Sleep Endoscopy (DISE) before surgery. Mean Apnea Hypopnea Index (AHI) preoperative was 32.9/h, AHI postoperative was 11.9/h, and mean reduction of AHI was 62.3%. The most commonly adopted palatoplasty was Barbed Repositioning Pharyngoplasty (BRP) in 16 out of 26 studies, followed by its subsequent modifications in 3 studies. Barbed pharyngoplasties appear to be effective both on objective measurement and subjective scores. DISE represents a fundamental tool to assess uni-level or multilevel obstruction. When retro-palatal collapse is present, barbed pharyngoplasty appears to be effective. Barbed pharyngoplasties maintain their good results both in single level or multilevel surgery. Randomized clinical controlled trials with multi-center cooperation and long-term study are necessary.

Barbed Pharyngoplasty for Snoring: Does It Meet the Expectations? A Systematic Review.

To date, the use of barbed sutures for the surgical management of patients suffering from obstructive sleep apnea and snoring with retropalatal collapse and vibration has significantly increased. A systematic review was carried out, which included clinical studies that used barbed sutures for the treatment of snoring. A qualitative analysis, including six clinical studies, was conducted. Of these, five were studies on barbed pharyngoplasties, and one study involved a minimally invasive surgical procedure. The population consisted of 176 patients, aged 26 to 58 years old. Overall, the included studies showed a mean gain in the snoring Visual Analog Scale of 5.67 ± 1.88, with a mean preoperative value of 8.35 ± 1.17 and a postoperative value of 2.68 ± 1.27. No major complications were described. Given the lack and heterogeneity of this evidence, the conclusion calls for being cautious. In carefully selected snorers and obstructive sleep apnea patients, the use of barbed sutures could represent a valid therapeutic strategy for snoring, ensuring a statistically significant improvement in the subjective parameters. Further studies on a larger scale that assess the role of barbed pharyngoplasties in snoring surgery and more extended follow-up studies are needed in order to confirm these promising results.

Palatal Implantation Using Platelet Rich Plasma and Radio Frequency Palatal Surgery for Management of Obstructive Sleep Apnea

Background: Obstructive Sleep Apnea (OSA) is a common health problem affecting large number of people all over the world with great psychological and physiological burdens. The aim of this study is to investigate the effect of radio frequency palatal Surgery and platelet rich plasma in the soft palate as a new technique in treatment of obstructive sleep apnea OSA. Patients and Methods: This study included 30 patients with mild to moderate OSA Group A: n=15 (Tonsillectomy and palatal radio frequency surgery) and Group B n=15 (Tonsillectomy and Platelet Rich Plasma (PRP) palatal injection, this study investigate the effect of body mass index, retropalatal anteroposterior diameter, Epworth Steepness Scale Apnea Hypopnia Index in treatment of OSA in both groups. This study found that both techniques improved day time sleepiness with reduction of Apnea-Hypopnea Index (AHI), also there was marked improvement in radiological parameters in the form of increase of the anteroposterior diameter and retro-palatal cross section area, there was reduction of Body Mass Index BMI in postoperative in both groups but there was superiority of group A over group B in improvement of this parameters, group A success rate was 86.6% and Group B was 80%. Conclusion: Radio frequency palatal surgery and platelet rich plasma, both are effective as a treatment of obstructive sleep apnea due to retro-palatal collapse.

Palatoplasty versus radiofrequncy palatal surgery for management of obstructive sleep apnea

Background: Obstructive sleep apnea (OSA) is a huge problem affecting large sector of people all over the world with great social and physiological effects. The aim of this study is to investigate the effect of radio frequency palatal. Surgery and palatoplasty in treatment of obstructive sleep apnea OSA. Patients and Methods: This study included 70 patients with mild to moderate OSA Group A: n=35 (Tonsillectomy and palatal radio frequency surgery) and Group B n=35 (Tonsillectomy and palatoplasty), this study investigate the effect of radio frequncy technique and palatoplasty on retropalatal anteroposterior diameter, Epworth Steepness Scale, apnea Hypopnia Index in Treatment of OSA. Results: This study found that both techniques improved day time sleepiness with reduction of apnea- hypopnea index (AHI), also there was marked improvement in radiological parameters in the form of increase of the anteroposterior diameter and retro-palatal cross section area, in postoperative in both groups but there was superiority of group A over group B in improvement of this parameters, group A success rate was 81.3% and Group B was 78.6% Conclusion: radio frequency palatal surgery and palatoplasty both are effective as a treatment of obstructive sleep apnea due to retro-palatal collapse.

Trans-hyoid hyoidthyroidpexy: A modified technique for selected cases of obstructive sleep apnea

ObjectiveHypopharyngeal collapse (HC) considered a challenge in surgery of obstructive sleep apnea (OSA). Several procedures were presented to deal with HC indirectly via providing support to the lateral walls of the hypopharynx preventing transverse collapse but hyoidthryoidpexy had gained more popularity. The procedure aimed to fix the mobile hyoid bone to a rigid mid-line neck structure, thus preventing the bone and its attached muscles from collapsing during sleep with the negative intrathoracic pressure on inspiration. Study designA prospective case series study. MethodsFrom April 2018 to January 2020, A Modified Technique of Trans hyoid hyoidthyroidpexy was applied for all included patients (24) patients with symptoms of OSA showing predominant lateral wall collapse of the hypopharynx (with retro-palatal collapse) with other OSA surgery. Results6–8 months postoperatively, the Apnea Hypopnea index dropped from 43.75 ± 8.44 to 16.28 ± 7.35 (P < 0.0001; t = 10.6988). 14 patients (58.33%) were reported as successful while 7 patients (29.17%) were considered responders and three patients (12.5%) were considered non responders. The mean lowest oxygen desaturation elevated from 77.56 ± 5.64 to 92.38 ± 6.25 (p < 0.0001). Epworth Sleepiness Scale improved (P < 0.0001) from 16.85 ± 4.23 to 5.17 ± 3.89. ConclusionTrans-hyoid hyoidthyroidpwxy is a modified technique of hyoidthyroidpexy. The procedure reported good outcomes in treating OSA. It is a simple, cost-effective and less traumatic technique. It could be combined with other multilevel surgical procedures.

Tongue-Based Procedures in Treating Refractory Obstructive Sleep Apnea in Down Syndrome Patients: A Systematic Review and Meta-Analysis

Objective: There is a high prevalence of obstructive sleep apnea (OSA) in pediatric and adult Down Syndrome (DS) patients that is refractory to adenotonsillectomy and continuous positive airway pressure. Newer treatment modalities have emerged with improved outcomes. The objective is to provide an updated systematic review and meta-analysis to analyze the clinical outcomes of OSA in pediatric and adult DS patients with hypoglossal nerve stimulation using Inspire, midline posterior glossectomy plus lingual tonsillectomy (MPG + LT), and combined genioglossus advancement plus radiofrequency (GGS + RF). Methods: A comprehensive literature search of PubMed and Google Scholar was performed followed by a meta-analysis. Studies with preoperative and post-operative Apnea Hypopnea Index (AHI) values were included with patients serving as their own control. Results: Across 5 studies, 56 patients were analyzed. The mean reduction in AHI was statistically significant before vs. after procedure ( P &lt; .001 for hypoglossal nerve stimulation using Inspire with a paired 2-tailed t-test and P = .031 for MPG + LT). Although individual patient AHI values were unavailable in the GGS + RF study, the standard difference in mean AHI was also significant for GGS + RF with P = .001. Device malfunction was the most common complication for Inspire while postoperative bleeding was observed for MPG + LT and nasopharyngeal obstruction and retropalatal collapse were observed for GGS + RF. Conclusion: This review reveals significant improvement in AHI with Inspire, MPG + LT, and GGS + RF for DS patients with refractory OSA. Further investigation is needed for comparison between these 3 therapies.

Positional awake nasoendoscopic pattern-based surgical decision for correction of retropalatal obstruction in OSA.

To evaluate differential surgical interventions for obstructive sleep apnea (OSA) patients with single-level retropalatal based on the preoperative topographical diagnosis using nasoendoscopy with Müller's maneuver during supine position (MM-P). This case series included adult patients with OSA who showed a predominant single-level retropalatal collapse on MM-P. An anteroposterior pattern of collapse was managed by an anterior advancement procedure, while a transverse pattern of collapse was managed by lateral/anterolateral advancement procedures (double suspension sutures). A combined procedure was provided to the concentric type of collapse. All patients underwent evaluation of the polysomnography, Epworth Sleepiness Scale (ESS) values and snoring scores both preoperatively and 6-8months after surgery. Among 102 patients, the most commonly reported pattern of collapse at the retropalatal level was the concentric pattern (48.04%) followed by the transverse pattern (27.45%). The AP-pattern of collapse was reported in 24.51%. In the postoperative follow-up visits, no early or late complications were reported. All included groups showed significant improvement in polysomnographic data (mean AHI and lowest O2 saturation level). Significant improvement of VAS of snoring was reported. The overall success rate was ˃90%. Preoperative differential diagnosis of OSA with MM-P allows for tailored surgical management. Tailored procedures could yield good surgical outcomes when patients are properly selected and the technique is chosen according to preoperative topographical diagnostic assessment. This study might provide an available less-costly and effective preoperative planning for OSA intervention. 4.

Barbed Suture Needle Rescue Procedure

Recently, the use of barbed sutures (BS) for the treatment of retro-palatal collapse and vibration in patients affected by snoring and obstructive sleep apnea (OSA) has significantly increase and surgeons have become more familiar with advantages and disadvantages of using this new technology. However, in the common surgical practice, there are some problems related to the use of BS and few technical solutions have been described. One problem still unsolved is when the needle becomes unusable. Today, there is still no recognized procedure for this critical intraoperative problem that forces the surgeon to cut the thread and start the procedure all over again. We describe an easily repeatable technique called “barbed suture needle rescue procedure” to solve this critical problem and allow the surgeon to complete the procedure.

Different barbed pharyngoplasty techniques for retropalatal collapse in obstructive sleep apnea patients: a systematic review.

The use of barbed sutures (BS) for the treatment of retropalatal collapse and vibration in patients suffering from snoring and obstructive sleep apnea (OSA) has significantly increased in the last few years. Many surgeons have discovered the advantages and unique properties of the BS and allowed the popular surgical pharyngoplasty techniques to be updated and improved. A systematic review was performed to identify all the clinical studies concerning the different barbed pharyngoplasty (BP) techniques used for the treatment of palatal collapse in snoring and OSA patients. A qualitative analysis of data extracted was conducted. We included 12 studies of which 10 are prospective and 2 retrospective: 9 single-arm studies on the efficacy of a specific BP technique, 1 randomized clinical trial on the comparison between BP and control groups, and 2 studies on the correlation between two different BP techniques. To date, in the literature, 5 different types of BP techniques have been described: barbed snore surgery, barbed reposition pharyngoplasty, barbed expansion sphincter pharyngoplasty, barbed suture suspension, and barbed soft palate posterior webbing flap pharyngoplasty. All the studies showed an overall improvement in the primary efficacy parameters investigated (apnea-hypopnea index, oxygen desaturation index, and Epworth sleepiness scale) in each of the surgical techniques performed without any major complications. Given the extreme heterogeneity of the studies analyzed, it is necessary to perform more randomized and control studies on large samples aimed to define the best BP technique based on its effectiveness, surgical success rate, patient's compliance, and complications.

Palatal implant system can provide effective treatment for obstructive sleep apnea by recovering retropalatal patency

Objective. Obstructive sleep apnea (OSA) is a disorder with a high prevalence rate that may induce serious complications. Recent progress in the area of hypoglossal nerve stimulation has played a role as an alternative to conventional therapies though, some patients having retropalatal collapse still have not benefitted. Therefore, here we propose a new type of upper-airway stimulation, referred to as the palatal implant system, which recovers the upper-airway patency by electrically stimulating the soft palate. Approach. The system consists of two major parts: an implant that stimulates the soft palate through electrodes and an intra-oral device that delivers power and data simultaneously to the implant via an inductive link. Evaluations of the system are conducted in bench-top, in vitro, and in vivo tests to evaluate its feasibility as an OSA treatment, and the potential development of the system is addressed in the discussion section. Main results. In the bench-top test, the power efficiency was 12.4% at d = 5 mm and the system could operate up to 8 mm distance in a bio-medium. Data transmission was also successful at distances ranging 2 to 8 mm within an error margin of 10%. The measured CSCc and the impedance magnitude of the electrode were 62.25 mC cm−2 and 390 Ω, respectively, proving a feasibility of the electrode as a stimluator interface. The system was applied to a rabbit and contraction of the soft palate muscle was recorded via a C-arm fluoroscopy. Significance. As a proof of concept, we suggest and demonstrate the palatal implant system as a new therapy for those undergoing treatment for OSA.

An Assessment of the Surgical Results of the Site-Directed Surgical Treatment in Obstructive Sleep Apnoea Syndrome

Background: Obstructive sleep apnea (OSA) has cardiovascular, neurological, and social complications. Surgical treatment has the potential to improve airway patency but when and which surgery should be done is a controversy. Aims and objectives: To estimate the site of obstruction in patients with OSAS and to assess the surgical results of the site (of obstruction) directed surgical treatment. Methodology: Twenty patients with OSAS were included in the study with Eight adults and Twelve children. It was a prospective study. All patients were assessed for the airway collapse and surgery was done accordingly. Repeat PSG was done after surgery for success rate after 4 months of follow up. Result: 17 patients successfully completed the follow-up. Four (50%) adults and Two (17%) children have grade I or II tonsils while Four (50%) of adults and Ten (83%) children have tonsil size grade III or IV. Seven (88%) adults and one (8%) of the children have adenoid hypertrophy up to grade II. One adult (12%) and nine children (75%) have grade III Adenoid size. Two children (17%) have Adenoid grade IV size. In Four patients retropalatal more than retroglossal collapse was found (50%). One patient (12%) had retroglossal more than retropalatal collapse other one had only retropalatal collapse, and the other one had retroglossal collapse. ESS (Epworth sleepiness scale) decreased postoperatively in both groups. There is a significant change in AHI with the median pre-op AHI being 40.19 to median post-op AHI being 11.35 with a p-value 0.017. Apnea-hypopnea index (AHI) in children pre-operatively was 12.98 (median) changed to 2.15 (median) which is statistically significant. Only one adult patient (12%) is surgically cured while in five patients (63%) surgical success achieved with a surgical success rate of 5/8 (63%). Whereas only one patient is surgically cured 1/8 (13%). Eight patients achieved surgical success with a total success rate of 8/9 (89%). While only two patients achieved surgical cure (23%) among children. Conclusion: The outcome of site-directed surgical treatment is that it is a satisfactory way of treatment of OSAS with an overall success rate of 76%.

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

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

Outcomes of Hypoglossal Nerve Upper Airway Stimulation among Patients with Isolated Retropalatal Collapse.

To examine whether patients with isolated retropalatal collapse perform as well as others following implantation with an upper airway stimulation (UAS) device. Retrospective review. Single-institution tertiary academic care medical center. Following drug-induced sleep endoscopy, subjects who met inclusion criteria for implantation with a UAS device received an implant per industry standard. Subjects with isolated retropalatal collapse were compared with those having other patterns of collapse. Outcome measures included apnea-hypopnea index (AHI) and nadir oxyhemoglobin saturation (NOS). Ninety-one patients were implanted during the duration of the study, and 82 met inclusion criteria for analysis. Twenty-five had isolated retropalatal collapse, while the remaining 57 had other patterns of collapse on drug-induced sleep endoscopy. For all patients, mean preoperative AHI and NOS were 38.7 (95% CI, 35.0-42.4) and 78% (95% CI, 75%-80%), respectively; these improved postoperatively to 4.5 (95% CI, 2.3-6.6) and 91% (95% CI, 91%-92%). There was no significant preoperative difference between groups with regard to demographics, AHI, or NOS. Group comparison showed postoperative AHI to be 5.7 (95% CI, 0.57-10.8) for patients with isolated retropalatal collapse and 3.9 (95% CI, 1.7-6.1) for other patients ( P = .888). Postoperative NOS was 92% (95% CI, 90%-94%) among patients with isolated retropalatal collapse and 91% (95% CI, 90%-92%) for others ( P = .402). All patients showed significant improvement following implantation with UAS. Patients with isolated retropalatal collapse showed similar improvement to other types of collapse with regard to AHI and NOS.

Single versus double suspension sutures for selected cases of obstructive sleep apnea

ObjectiveTo compare the results of expansion pharyngoplasty using bilateral single palatal suspension sutures (SSS) versus double suspension sutures (DSS) for the treatment of selected cases of obstructive sleep apnea (OSA) with retropalatal collapse. MethodsPatients were randomly categorized into two groups: the first group for whom bilateral SSS were performed and a second group for whom bilateral DSS were done. Snoring on the basis of the visual analog scale (VAS), Epworth Sleepiness Scale (ESS), apnea hypopnea index (AHI), lowest O2 saturation were assessed preoperatively and 6 months postoperatively in all patients. ResultsDSS provided significantly more retroplatal space (p = 0.0137) and less snoring score (p = 0.0005). While no significance difference between SSS and DSS as regard inter pillar distance (p = 0.0985), AHI (p = 0.1677), ESS (p = 0.4094), and lowest O2 saturation (p = 0.0839). ConclusionBoth SSS and DSS are simple, rapid, bloodless and effective procedures for treating OSA (in patients with retropalatal collapse) with no temporary or persistent postoperative complications. Adding the second suture in DSS could significantly enlarge more retropalatal space and reduce more snoring scale than SSS.

Long-term results of palatal implantation for severe obstructive sleep apnea patients with prominent retropalatal collapse

BackgroundMost previous reports on palatal implantation for patients with severe obstructive sleep apnea have been anecdotal. Our objective in this study was to assess the long-term outcomes of palatal implantations from objective as well as subjective perspectives when applied to patients with severe obstructive sleep apnea and prominent retropalatal collapse. MethodsThis retrospective review was conducted in a single institution using subjective data (Epworth Sleepiness Scale and visual analog scales of snoring sounds and sleep quality) and objective data (respiratory disturbance index, minimum O2 saturation, sleep efficiency, and snoring index using a polysomnograph) before and after surgery. A total of ten patients were enrolled in this study. The median time between pre-operative sleep-related tests and the operation date was 1.0 months and the median time between operation date and post-operative sleep-related tests was 33.0 months. ResultsSignificant improvements were observed in the visual analog scale scores of snoring (p = 0.004), visual analog scale scores of sleep quality (p = 0.005), and Epworth Sleepiness Scale (p = 0.012). Eight of the ten patients reported a reduction of at least 50% on the visual analog scale of snoring sounds, which was the criterion of subjective surgical success. We also observed significant improvements in the respiratory disturbance index (p = 0.009) and minimum O2 saturation (p = 0.033). Two of the ten patients presented a reduction in respiratory disturbance index of ≥50% and a subsequent respiratory disturbance index of <20, which were the criteria of objective surgical success. A percentage change in respiratory disturbance index was negatively associated with prominent retrolingual collapse and the length of the soft palate. ConclusionPatients with severe obstructive sleep apnea and prominent retropalatal collapse may benefit from palatal implantation from a subjective perspective. Palatal implantation could be considered an alternate form of treatment for some cases of severe obstructive sleep apnea, due to the likelihood of improvement in clinical symptoms and the normalization of sleep quality.

Multidisciplinary Alternatives to CPAP Program for CPAP-Intolerant Patients.

Continuous positive airway pressure (CPAP) intolerance remains a persistent problem for many obstructive sleep apnea patients. Clinicians and researchers continue to search for other effective treatment modalities given the well-documented sequelae associated with untreated obstructive sleep apnea. A multidisciplinary "Alternatives to CPAP program" (ALT) can facilitate systematic evaluation of non-CPAP therapies appropriate for an individual patient. We review successful strategies and barriers encountered during implementation of an ALT at our institution. Creation of similar programs in private practice and academic settings can help medical, dental, and surgical sleep medicine specialists coordinate evaluation and treatment of CPAP-intolerant patients.

Obstructive sleep apnea in postmenopausal women: a comparative study using drug induced sleep endoscopy

IntroductionThe key to successful treatment of OSAS is to individually tailor such treatment. Thus, it is very important to determine the severity of OSAS, its pattern, and the extent of collapse, by gender, age, and BMI. ObjectiveThe objective of the study was to understand the characteristics of obstructive sleep apnea in postmenopausal women by comparing postmenopausal and premenopausal subjects, and men, using DISE. We hope that our work will help the medical community to consult on, diagnose, and treat OSAS more effectively. MethodsA total of 273 patients (195 males and 78 females) diagnosed with OSAS were enrolled. Female patients were divided into pre-menopausal (n=41) and post-menopausal patients (n=37). The group of post-menopausal female patients was matched with a group of male patients with similar age and body mass index (BMI). DISE findings were compared between pre-menopausal female patients and post-menopausal female patients, and also between post-menopausal female patients and male patients matched for age and BMI. ResultsUpon PSG examination, post-menopausal patients (who had a significantly higher BMI than did pre-menopausal patients; 25.6kg/m2 vs. 23.5kg/m2; p=0.019) tended to have a higher AHI and a lower lowest SaO2, but the differences did not attain statistical significance. With DISE analysis, post-menopausal female patients showed higher values in all obstruction sites, with significantly higher value in lateral diameter of retropalatal (1.49 vs. 0.90; p=0.001) and retrolingual levels (1.14 vs. 0.61; p=0.003) compared to pre-menopausal females patients. Post-menopausal female patients showed significantly more retrolingual collapse (antero-posterior, AP, p≤0.0001, and lateral diameter, p=0.042) in the lower BMI group (BMI<25) and more concentric retropalatal collapse (lateral diameter, p=0.017 and tonsillar obstruction, p=0.003) in higher BMI group (BMI≥25) than BMI and age matched male patients. ConclusionPost-menopausal female patients showed a different pattern of airway obstruction compared to pre-menopausal female patients and male patients matched for age and BMI based on DISE findings.

Effectiveness of oral pressure therapy in obstructive sleep apnea: a systematic analysis.

Oral pressure therapy (OPT) has emerged as a novel technique to treat obstructive sleep apnea (OSA) in the past few years. Given this is a relatively new treatment approach, currently, little is known with respect to its clinical utility. The aim of this review was to explore the success rate of OPT when used to treat OSA. PubMed, MEDLINE, Scopus, Web of Science, and the Cochrane Library databases were searched for pertinent studies. The OPT treatment success rates varied widely between 25 and 79% depending on the residual apnea-hypopnea index (AHI) cut off defined for treatment success. When using standard definitions (at least 50% reduction from the baseline AHI and the post-OPT treatment residual AHI less than or equal to 10), the success rate of OPT treatment varied between 25 and 37%. Although there was a significant reduction in AHI with OPT, the baseline AHI was not suppressed in majority of patients to the extent to call these patients as optimally treated. Successful treatment with OPT did not correlate with severity of OSA; however, patients with retro-palatal collapse responded better to treatment. Further research is needed to identify OSA patients who would benefit with this treatment modality.

Correlation Between Retropalatal Collapse as Observed During Muller's Maneuver to Severity of OSA.

Objective of the study was to evaluate the reliability of Muller's maneuver (MM) with the severity of obstructive sleep apnea (OSA) at the retropalatal level. Case series of 58 adult patients diagnosed to have OSA. Sleep apnoea clinic in a tertiary referral center in south India. Fifty-eight adult OSA patients underwent outpatient based MM under local anaesthesia. Collapse of hypopharynx and the retroglossal regions were assessed during a maximal inspiratory effort against the closed mouth and sealed nose (reverse valsalva). Correlation co efficient was used to compare MM grade with apnea-hypopnea index (AHI) scores. Severity of OSA based on AHI scores were compared with the results of Muller's maneuver at the retropalatal level. The correlation coefficient was 0.213, hence no correlation was found, p value was 0.019, which was not statistically significant. MM is an useful tool for evaluation of upper airway collapse. The advantages include simplicity, cost-effectiveness, relatively easy to perform, thorough evaluation of upper airway. The pitfalls of the procedure includes the subjectiveness of the procedure and the fact that it is performed on awake patients and therefore remains an indirect estimation of obstruction that occurs during sleep. In our study, we did not find correlation between the severity of OSA based on the AHI scores and the collapse at the retropalate level assessed by the Muller's maneuver.