Treatment Of Obstructive Sleep Apnea Research Articles

Gefapixant as a P2X3 receptor antagonist treatment for obstructive sleep apnea: a randomized controlled trial.

Obstructive sleep apnea (OSA) is a highly prevalent disorder with serious health consequences but limited therapeutic options. For a subset of those with OSA, a key underlying mechanism is hypersensitive chemoreflex control of breathing. There is no approved therapy that targets this endotypic trait. Here we determine whether the P2X3 receptor antagonist gefapixant, which is predicted to attenuate hypersensitive carotid chemoreflexes, reduces OSA severity in patients with chemoreflex-dependent OSA. In a randomized placebo-controlled cross-over study, 24 patients with moderate-to-severe OSA (aged 39-68 years, non-CPAP users) whose disorder was partially responsive to supplemental oxygen (chemoreflex-dependent OSA) were treated with gefapixant 180 mg (or placebo) administered as tablets taken orally before bedtime for 7 days and assessed via overnight polysomnography. The primary analysis examined whether gefapixant treatment resulted in a greater reduction in the apnea-hypopnea index (AHI) from baseline than placebo. Gefapixant did not lower the AHI significantly more than placebo; the estimated ratio of the AHI on gefapixant versus placebo was 0.92 [90% CI: 0.73, 1.17]. Notably, nocturnal hypoxemia was increased (ratio of total sleep time with SpO2 <90% on gefapixant versus placebo = 2.08 [90% CI: 1.53, 2.82]), consistent with reduced chemoreflex output. Commonly reported adverse events with gefapixant included ageusia, dysgeusia, oral hypoaesthesia, nausea, somnolence, and taste disorders. Gefapixant, while generally well tolerated, did not reduce OSA severity in patients with chemoreflex-dependent OSA. P2X3 receptor antagonism is unlikely to provide an avenue for therapeutic intervention in OSA. Registry: ClinicalTrials.gov; Name: Safety and Tolerability of Gefapixant (MK-7264) in Participants With Obstructive Sleep Apnea (MK-7264-039); URL: https://clinicaltrials.gov/study/NCT03882801; Identifier: NCT03882801.

Mandibular advancement device in obstructive sleep apnea treatment: what happens to the condyle position and patient response?

This study aims primarily to assess the mandibular condyles and patient response to MAD therapy using cone-beam computed tomography (CBCT). Also, the study proposes to analyze whether variations in condylar position, OSA severity and mandibular protrusion influence patient response. 23 patients diagnosed with mild/moderate OSA and treated with MAD comprised the sample. Clinical, CBCT, and PSG assessments were conducted at baseline and with MAD in therapeutic protrusion (4-6 months of MAD use). The condyle position was vertically and horizontally evaluated at baseline and at the therapeutic protrusion. The condyle position significantly changed with MAD, showing anterior (7.3 ± 2.8mm; p < 0.001) and inferior (3.5 ± 1mm; p < 0.001) displacement. Patients with mild OSA required more protrusion (p = 0.02) for improvement. Responders exhibited a significantly prominent (p = 0.04) anterior baseline condyle position. A negative modest correlation was found between treatment response and baseline condyle anterior position (p = 0.03; r=-0.4), as well as between OSA severity and the percentage of maximum protrusion needed for therapeutic protrusion (p = 0.02; r=-0.4). The patient protrusion amount did not predict condylar positional changes. Neither condyle position, OSA severity, nor therapeutic protrusion were predictors of MAD treatment response. MAD resulted in anterior and inferior condylar displacement, and the amount of protrusion did not predict condylar positional changes. Responders showed a more anterior baseline condyle position. OSA severity and mandibular protrusion did not predict treatment response.

Adverse Events with Hypoglossal Nerve Stimulation in the Treatment of Obstructive Sleep Apnea—A Systematic Review of Clinical Trials and Real-World Data

Background/Objectives: Hypoglossal nerve stimulation (HNS) emerged as an alternative treatment for patients with obstructive sleep apnea (OSA) a decade ago. Long-term clinical trials and real-world data show that HNS treatment provides significant and sustained improvements in both OSA disease control and quality-of-life measures over time. Given the nature of HNS treatment, with the requirement of using an implantable neurostimulation system, patient safety is a critical domain in the assessment of this technology. The objective of this review was to evaluate adverse events (AEs) and complications with HNS therapy in a systematic review of published evidence. Methods: Medline, Cochrane, and Web of Science were systematically searched to identify randomized controlled and real-world observational studies reporting relevant outcomes with HNS therapy for treatment of OSA that included procedure-, device-, and treatment-related AEs. Results: Out of 418 articles screened, 27 were reviewed for eligibility, and 17 studies, the majority found to have low-to-moderate risk of bias, with data on 1962 patients were included for further analysis. Across included studies, reporting of AEs was heterogeneous with regard to the classifications used and the extent of reporting. Over an average follow-up duration of 17.5 ± 16.9 months, the pooled mortality rate was 0.01% (95% CI = 0.0 to 0.2%), with all reported deaths being unrelated to HNS treatment. The HNS system survival probability over the follow-up time of 60 months was 0.9834 (95% CI = 0.9768 to 0.9882), with infections and request for removal by patients being the most common indications. The pooled surgical revision rate was 0.08% (95% CI 0.0 to 0.2%). Most reported treatment-related side effects were transient stimulation-related discomfort (0.08%, 95% CI = 0.0 to 0.2%) and tongue abrasions (0.07%, 95% CI = 0.0 to 0.2%). Based on the systematic review, a standardized set of endpoints was defined, aiming to harmonize safety data relevant to HNS therapy. Conclusions: In this systematic review, HNS therapy for treatment of OSA is associated with a positive patient safety profile. AEs occur mainly at device implantation and during the treatment acclimatization period. Due to a lack of available evidence, partially implantable HNS systems are underrepresented in this review, which limits the generalizability of the results. Significant heterogeneity was found for adverse event reporting. A framework for reporting HNS outcomes that includes AEs and side effects is proposed to facilitate comparability of the reported data.

Hypnotics on Obstructive Sleep Apnea Severity and Endotypes: A Systematic Review and Meta-Analysis.

Low arousal threshold and poor muscle responsiveness are common determinants of obstructive sleep apnea (OSA). Hypnotics were hypothesized as an alternative OSA treatment via raising the arousal threshold and possibly genioglossus responsiveness. Effect of common hypnotics on arousal threshold, OSA severity and genioglossus responsiveness. We searched MEDLINE, EMBASE, CENTRAL and ClinicalTrials.gov for randomized clinical trials, and ran meta-analyses to determine the effect of oral hypnotics on arousal threshold, OSA severity and genioglossus responsiveness. GRADE was used to rate the quality of evidence (QoE). The association between post-treatment AHI and arousal threshold percent reductions was explored in individual patient data (IPD) metanalyses (overall sample and low arousal threshold subgroups). Based on our analysis (27 studies; 25 for AHI, 11 for arousal threshold, 4 for genioglossus responsiveness), hypnotics minimally raised arousal threshold (mean difference [95% CI]: 2.7 [1.5, 3.8] cmH2O epiglottic pressure swings; moderate QoE), but did not change OSA severity (1.4 [3.5, 0.7] events/h; moderate QoE). IPD meta-analysis (N=114) showed no association between changes in arousal threshold and AHI, independent of low arousal threshold subgrouping. However, people with very-low arousal threshold or those who exhibited 0-25% arousal threshold increase from placebo experienced the greatest-yet still modest-post-treatment AHI reductions (10%). Hypnotics did not affect genioglossus responsiveness (high QoE). Further research testing or clinical use of hypnotics as OSA alternative treatments should be discouraged, unless in the presence of comorbid insomnia or as part of combination therapy in individuals with very-low arousal threshold.

A comparison of the outcomes of tonsillectomy and expansion sphincter pharyngoplasty operations in patients with obstructive sleep apnea

ABSTRACT Objective To compare the efficacy of tonsillectomy and expansion sphincter pharyngoplasty (ESP) in the surgical treatment of obstructive sleep apnea (OSA). Methods OSA patients with Friedman grade III-IV tonsil hypertrophy diagnosed with polysomnography were separated into two groups according to the surgery performed, as the classic tonsillectomy group (Group 1) and the ESP group (Group 2). The primary endpoint of the study was to determine the Apnea-Hypopnea Index (AHI) value. Results Group 1 comprised 24 patients with median preoperative AHI of 19.7 and postoperative AHI of median 11.8 (p = .0001). Group 2 comprised 29 patients with median preoperative AHI of 25.1 and postoperative AHI of median 16.3 (p = .0001). Nine (37.5%) of the 24 patients in Group 1 accepted as cure (79.1%). Eight (27.5%) of the 29 patients in Group 2 accepted as cure (72.4%). Conclusion There was no superiority of ESP over tonsillectomy in patients with lateral pharyngeal obstruction.

Obstructive Sleep Apnea and Short-Term Outcomes After Pediatric Cardiac Surgery.

Obstructive sleep apnea (OSA) has been associated with negative cardiovascular effects and negative outcomes following cardiovascular surgery in the adult population. Our objective was to evaluate if there is a similar association in children. Single center retrospective matched cohort study, we collected data on patients aged 1-18 who were admitted to the cardiac intensive care unit (CICU) between Jan 2012 and Dec 2021. We used a 3:1 propensity score matching for cases not diagnosed with OSA. Primary outcome was a composite variable: "adverse outcome," consisting of prolonged hospital and CICU stay, prolonged duration of mechanical ventilation, need for extracorporeal membrane oxygenation, and death. The study comprised 80 patients diagnosed with OSA and 240 patients without a diagnosis of OSA before cardiac surgery. The median age was 5.3years (IQR 2.7-11.2). There were 184 (57.5%) males, and 102 (31.9%) had chromosomal and genetic abnormalities. There was a difference in "adverse outcome" between the OSA and non-OSA groups [34 (42.50%) vs 68 (28.33%), p = 0.027]. Moreover, bivariate analysis revealed that CICU length of stay, and chromosomal anomalies were statistically different between the groups. By logistic regression the composite variable "adverse outcome" remained associated to the OSA group (p = 0.009) with an adjusted odds ratio (OR) of 4.09 (1.83-9.18), p < 0.001. Children diagnosed with OSA had a higher risk of "adverse outcome" following cardiac surgery. The risk disappeared if the patient had Tonsillectomy and Adenoidectomy before cardiac surgery. Further studies should explore a proactive treatment for OSA in pediatric patients who need cardiac surgery.

The utility of various predictive equations in patients with severe Obstructive Sleep Apnea: a clinical practice viewpoint in settings with limited resources

BackgroundThe continuous positive airway pressure (CPAP) needed for the treatment of obstructive sleep apnea (OSA) can be determined after a manual titration study which is often expensive and time consuming. Hence, different predictive equations were suggested to simplify the treatment of OSA. The purpose of this work was to compare the CPAP identified with manual titration with that calculated using various equations in a cohort of patients with severe OSA.MethodsThis work was conducted on patients diagnosed with severe OSA. Data collected included full medical history, demographic and anthropometric measures, polysomnography results, and the CPAP pressure obtained after manual titration which was further compared to 15 predictive equations retrieved from the literature.ResultsA total of 166 patients [137 (82.5%) males and 29 (17.5%) females] with severe OSA were recruited in the study. Their mean age was 55.91 ± 12.64, and their baseline diagnostic apnea hypopnea index was 71.75 ± 23.70. The mean CPAP manual titration pressure was 11.31 ± 2.9 cmH2O. Non-significant statistical difference was found (p > 0.05) when the mean titration pressure was calculated by Eqs. 2 (11.36 ± 2), 3 (11.55 ± 1.68), 10 (11.51 ± 2.29), 11 (11.14 ± 2.04), and 14 (11.71 ± 2.06), whereas the mean titration pressure calculated by Eqs. 1, 4, 5, 6, 7, 8, 9, 12, 13, and 15 differed significantly from the manual titration pressure (p < 0.05).ConclusionPredictive equations suggested to calculate CPAP pressure, albeit simple and easy to apply, yielded variable results and should be investigated carefully before their use into clinical practice.

Major clinical results of orthognatic surgery in obstructive sleep apnea syndrome: a systematic review

Introduction: Obstructive sleep apnea involves obstruction or narrowing of an individual's airways during sleep and is associated with several comorbidities. Management can be surgical or non-surgical, and Phase II of the Stanford Protocol for surgical management involves maxillomandibular advancement. Objective: To conduct a concise systematic review to present the main considerations and clinical results of orthognathic surgery in obstructive sleep apnea syndrome. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from April to June 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 110 articles were found, 41 articles were evaluated and 23 were included in this systematic review. Considering the Cochrane tool for risk of bias, the global assessment resulted in 28 studies with a high risk of bias and 28 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X2 =88.5% &gt;50%. Maxillomandibular advancement surgery is a successful treatment for obstructive sleep apnea, but there are still concerns about cosmetic results due to the major advances involved. Bimaxillary advancement osteotomy significantly increases oropharyngeal volume and contracted superficial areas, which remain stable between 6 months and 1 year postoperatively.

Case Report: Multidisciplinary Treatment of Obstructive Sleep Apnea and Dental Malocclusion

Case Report: Multidisciplinary Treatment of Obstructive Sleep Apnea and Dental Malocclusion

Case Report: Multidisciplinary Treatment of Obstructive Sleep Apnea and Dental Malocclusion

Case Report: Multidisciplinary Treatment of Obstructive Sleep Apnea and Dental Malocclusion

Impact of lifestyle interventions targeting physical activity and healthy diet on treatment of Obstructive Sleep Apnea (OSA)

Introduction and purpose: Obstructive Sleep Apnea Syndrome (OSAS) is a worldwide prevalent sleep-related medical condition characterised by upper airway collapse, leading to hypoxia and hypercapnia. Excess body weight is the risk factor of OSAS. Lifestyle interventions, particularly targeting weight loss, have emerged as potential management strategies for OSAS. The purpose of this review is to compile the information about the effectiveness of different forms of lifestyle interventions in the treatment of OSA. Brief description of the state of knowledge: While CPAP remains the current “gold standard” treatment of Obstructive Sleep Apnea, it’s not always well-tolerated. Consequently, lifestyle interventions such as dietary modifications, exercise programs, and behavioural therapies have emerged as important components in the management of this disease. The research has shown that these strategies not only reduce the severity of OSA but also improve quality of life. Summary: Lifestyle interventions, including dietary modifications, exercise programs, and behavioral therapies targeting weight loss, have demonstrated promising results in reducing the severity of obstructive sleep apnea (OSA) and alleviating associated symptoms. However, further large-scale, long-term studies are necessary to validate their efficacy and understand their broader impact on OSA management.

Impact of lifestyle interventions targeting physical activity and healthy diet on treatment of Obstructive Sleep Apnea (OSA)

Introduction and purpose: Obstructive Sleep Apnea Syndrome (OSAS) is a worldwide prevalent sleep-related medical condition characterised by upper airway collapse, leading to hypoxia and hypercapnia. Excess body weight is the risk factor of OSAS. Lifestyle interventions, particularly targeting weight loss, have emerged as potential management strategies for OSAS. The purpose of this review is to compile the information about the effectiveness of different forms of lifestyle interventions in the treatment of OSA. Brief description of the state of knowledge: While CPAP remains the current “gold standard” treatment of Obstructive Sleep Apnea, it’s not always well-tolerated. Consequently, lifestyle interventions such as dietary modifications, exercise programs, and behavioural therapies have emerged as important components in the management of this disease. The research has shown that these strategies not only reduce the severity of OSA but also improve quality of life. Summary: Lifestyle interventions, including dietary modifications, exercise programs, and behavioral therapies targeting weight loss, have demonstrated promising results in reducing the severity of obstructive sleep apnea (OSA) and alleviating associated symptoms. However, further large-scale, long-term studies are necessary to validate their efficacy and understand their broader impact on OSA management.

Decisional Needs of Veterans With Mild Traumatic Brain Injury Initiating Treatment for Insomnia Disorder and Obstructive Sleep Apnea.

We sought to elicit key informant (KI) perspectives regarding decisional needs of Veterans with mild traumatic brain injury (mTBI) who are initiating insomnia disorder and obstructive sleep apnea (OSA) treatment within the Veterans Health Administration (VHA) Polytrauma/TBI System of Care (PSC). Specifically, we sought to understand: (1) information regarding treatment options that Veterans with mTBI require in order to make an informed decision; and (2) values used to guide decision-making (ie, personally meaningful aspects of the decision used to compare treatment options). Nationwide VHA PSC sites. Clinicians included VHA providers and policymakers involved in the management of mTBI and/or sleep disorders in the VHA PSC (n =29). Veterans included those with a clinician-confirmed mTBI who received care for insomnia disorder and/or OSA within the past year (n =20). Semi-structured interviews with the 49 KIs were recorded and transcribed verbatim. Themes were identified using a descriptive and interpretive approach to qualitative analysis. Not applicable. Informational needs identified by both KI groups included information regarding outcomes and downsides of treatment, accessible delivery, treatment candidates, description of diagnosis, and level of commitment. Values used to guide decision-making for both insomnia disorder and OSA treatment included benefits, downsides, and availability of treatments. Values used to decide on insomnia treatments alone included time commitment, intrinsic management of sleep, beliefs regarding mental health treatment, and time course of benefit. Values used to decide on OSA treatment alone included intrusiveness of the treatment, appearance, and impact on bed partners. The current study revealed the decisional needs of Veterans with mTBI who are initiating sleep disorder treatment. Findings can inform the development of decision aids and other efforts aimed at promoting patient-centered management of comorbid mTBI and sleep disorders, thereby improving care quality and clinical outcomes.

Efficacy of Barbed Reposition Pharyngoplasty and Uvulopalatopharyngoplasty for Retro Palatal Obstruction

Abstract Background Obstructive sleep apnoea (OSA) is a common problem affecting almost 4% of the population. Although continuous positive airway pressure (CPAP) is considered the standard of care, the patient compliance for long term use is poor. Clinicians have explored surgical options for cure with varying success. Objective To analyze the efficacy of a new modified pharyngoplasty technique (BRP) in comparison with other UPPP techniques to displace the soft palate anteriorly and lateralize the lateral pharyngeal wall in the treatment of OSA. Patients and Methods Types of studies: Systematic review/Meta-analysis. Types of participants: Patients Complain of OSA caused by mild to moderate retropalatal obstruction. Study outcome: efficacy of barbed suture and UPPP operations for retropalatal obstruction, study of success rate. Study of failure rate. Study of complications. Results Regarding Change in ODI Associated with Barbed Sutures, it was found that only 2 studies assessed ODI, and this analysis showed that Weighted mean difference = -23.32 (95% CI = -35.08 to -11.56). There is substantial heterogeneity across studies (Cochran Q test P-value = 0.099, I-squared = 63.33%). In the UPPP procedure, only two studies assessed the ODI, this analysis showed that the weighted mean difference = -14.27 (95% CI = -20.62 to -7.92). There is substantial heterogeneity across studies. Data Sources Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2021. Conclusion Both Barbed reposition pharyngoplasty and Uvulopalatopharyngoplasty techniques were effective in the treatment of cases with obstructive sleep apnoea (OSA). Barbed reposition pharyngoplasty (BRP) can be considered as the gold standard procedure. BRP seem to be more effective than UPPP in a single-level surgical setting. However, being quick, easy to learn and less invasive, BRP is a safe, effective and promising option for treatment of patients with OSA.

A Case for Pilates as Treatment for Obstructive Sleep Apnea

A Case for Pilates as Treatment for Obstructive Sleep Apnea

Comparative analysis of pain outcomes in hypoglossal nerve stimulation: Avoiding the digastric tendon

ObjectiveUpper airway stimulation effectively treats patients with obstructive sleep apnea, especially among those with low long-term compliance with continuous positive airway pressure. Traditional methods to implant the hypoglossal nerve stimulator involve retraction of the digastric tendon to identify the nerve and improve exposure for stimulator implantation. Transient submental pain and discomfort are known side effects of the procedure. Placement without retraction provides an alternative approach to minimize postoperative pain. This study compares post-operative pain outcomes of patients in whom the digastric tendon was and was not retracted. MethodsRetrospective chart review of patients who received the hypoglossal nerve stimulation implant at a single institution between 2017 and 2021. A combination of descriptive and qualitative data, including age, gender, comorbidities, and postoperative symptoms are analyzed to characterize patient outcomes resulting from this intraoperative technique. The categorical and continuous variables were analyzed using chi-squared tests and independent t-tests, respectively. ResultsPatients report overall satisfaction after implantation and titration. A total of 108 patients underwent HGNS implantation between September 2017 and January 2021 using the aforementioned techniques. 1.69 % of patients experienced postoperative submental pain as compared to 18.37 % prior to the change in technique (p < 0.01). ConclusionAvoidance of digastric tendon retraction in the implantation of the stimulating lead is a safe and effective technique that reduces postoperative pain and discomfort. Our institution has demonstrated an alternative technique for hypoglossal stimulator implantation which improves perioperative outcomes. Lay summaryUpper airway stimulation is an effective treatment for obstructive sleep apnea. During surgery, the digastric tendon is often moved to identify the nerve and improve access. This study shows that avoiding digastric tendon movement safely reduces postoperative pain and discomfort. Level of evidenceIII

Diagnosis and treatment of obstructive sleep apnoea in patients with pauses in Holter ECG monitoring: case series

Diagnosis and treatment of obstructive sleep apnoea in patients with pauses in Holter ECG monitoring: case series

Comparison of high flow nasal cannula therapy to nasal oxygen as a treatment for obstructive sleep apnea in infants.

Obstructive sleep apnea (OSA) in infants is treated with low flow oxygen via nasal cannula (NC), CPAP (continous positive airway pressure), or surgery. Literature supports the use of high flow NC (HFNC) in children in the outpatient setting, however there is limited data on the use of HFNC in infants. The purpose of this study was to compare HFNC and low-flow oxygen as treatments for OSA in infants. A prospective pilot study was performed at two institutions. Infants with primarily OSA underwent a 3-4 h sleep study with HFNC titration at 6-14 lpm for OSA, followed by clinical polysomnography (PSG) for oxygen titration (1/8-1 lpm). Infants with primarily central apnea were excluded. Nine infants were enrolled, with a mean age of 1.3 ± 1.7 months. Average apnea hypopnea index (AHI), average obstructive apnea hypopnea index (OAHI) and average central apnea index during the diagnostic PSG was 17.2 ± 7/h, 13.4 ± 5.4/h and 3.7 ± 4.8/h respectively. OSA improved in 44.4% of subjects with HFNC; the mean AHI and OAHI decreased from 15.6 ± 5.65/h and 12.8 ± 4.4/h on diagnostic PSG to 5.12 ± 2.5/h and 4.25 ± 2.5/h on titration PSG. OSA improved universally with low flow oxygen; the mean AHI decreased from 17.2 ± 7/h on diagnostic PSG to 4.44 ± 3.6/h on titration PSG. HFNC reduced OSA in some infants, though low flow oxygen reduced OSA in all subjects. Respiratory instability (high loop gain) in infants may explain why infants responded to low flow oxygen. More studies are needed to determine if HFNC is beneficial in selected groups of infants with OSA.

Factors influencing hospital charges for tonsillectomy to treat obstructive sleep apnea in children.

This study investigates the impact of patient characteristics and demographics on hospital charges for tonsillectomy as a treatment for pediatric obstructive sleep apnea (OSA). The aim is to identify potential disparities in hospital charges and contribute to efforts for equitable access to care. Data from the 2016 Healthcare Cost and Utilization Project (HCUP) Kid Inpatient Database (KID) was analyzed. The sample included 3,304 pediatric patients undergoing tonsillectomy ± adenoidectomy for OSA. Variables such as age, race, length of stay, hospital region, residential location, payer information, and median household income were collected. The primary outcome variable was hospital charge. Statistical analyses, including t-tests, ANOVA, and multiple linear regression, were conducted. Among 3,304 pediatric patients undergoing tonsillectomy for OSA. The average total charges for tonsillectomy were $26,400, with a mean length of stay of 1.70 days. Significant differences in charges were observed based on patient race, hospital region, and payer information. No significant differences were found based on gender, discharge quarter, residential location, or median household income. Multiple linear regression showed race, hospital region, and residential location were significant predictors of total hospital charges. This study highlights the influence of patient demographics and regional factors on hospital charges for pediatric tonsillectomy in OSA cases. These findings underscore the importance of addressing potential disparities in healthcare access and resource allocation to ensure equitable care for children with OSA. Efforts should be made to promote fair and affordable treatment for all pediatric OSA patients, regardless of their demographic backgrounds.

Simultaneous use of GlideScope® in emergency department: A case report

The GlideScope® is a videolaryngoscope manufactured by Verathon Medical (Bothell, WA, USA), now widely used to manage planned or unexpected difficult orotracheal intubation situations. According to the current literature, GlideScope® has been used for surgical procedures involving the tongue base, such as biopsies and radiofrequency treatment of obstructive sleep apnea. We describe a case of dual use of GlideScope for pointed foreign body removal in an emergency department.