bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ambulatory Surgical Management of Obstructive Sleep Apnea: Is It Safe?
Authors: Weisstuch Adam , Butrymowicz Anna , Kidwai Sara M. , Parnes Steven M. 
Published: September 2014

Objectives:Determine the safety of ambulatory oropharyngeal surgery in adults with obstructive sleep apnea.Methods:Retrospective cohort study. Relevant data were collected from patients aged 18+ years with obstructive sleep apnea (OSA) receiving head and neck airway surgery between September 1, 2005, and September 15, 2012.Results:Out of 315 patients with complete data, 243 (77.14%) were managed as inpatients and 72 (22.86%) in an ambulatory manner. The mean Apnea/Hypopnea Index (AHI) for the inpatient and ambulatory groups were 35.99 and 18.43, respectively (P <. 00). The mean body mass index (BMI) for the inpatient and ambulatory groups was 34.12 and 30.79, respectively (P <. 0002). When calculating the incident risk ratio of changes in AHI or BMI, AHI exhibited a significantly increased contribution. There were no complications in the ambulatory cohort.Conclusions:When evaluating body habitus and polysomnographic data, OSA patients who underwent oropharyngeal procedures and were discharged on the same day were significantly different than those who were admitted to the hospital. It appears from this data that patients with mild‐moderate sleep apnea, even for patients with mild obesity, are safe to have these procedures performed in an ambulatory setting. This data could potentially assist practitioners in determining which procedures could be safely planned for an ambulatory setting and therefore decrease health care expenditures and patient inconvenience while maintaining patient safety. Future studies investigating what, if any, inpatient interventions were provided for those patients that were admitted to the hospital could potentially further expand the group of patient who could be safely managed in an ambulatory setting.
Cardiovascular Autonomic Function in Patients with OSA
Authors: Lin Hsin‐Ching , Friedman Michael 
Published: September 2014

Objectives:Prospectively investigate the cardiovascular autonomic function in patients with obstructive sleep apnea (OSA) and examine the relationship with OSA severity, since impaired cardiovascular autonomic response is independently associated with cardio‐ and cerebro‐vascular disease.Methods:Ninety‐one subjects with symptoms of sleep‐disordered breathing who underwent full‐night polysomnography were recruited. Standard autonomic parameters which include heart rate response to deep breathing, Valsalva ratio, baroreflex sensitivity (BRS), and heart rate variability were obtained for further analysis and correlated to severity of OSA.Results:Seventy‐three patients with OSA (apnea/hypopnea index, AHI ≥5/h) and 18 simple snore patients (AHI <5) as normal control were compared in this study. BRS was the only parameter with significant difference among the 2 groups (3.6 ± 1.2 in simple snore and 2.8 ± 1.4 in OSA patients, P =. 03). Further association analysis revealed significant correlation between BRS and AHI.Conclusions:This study shows OSA patients have blunted baroreceptor function compared to patients without OSA. Baroreceptor dysfunction may contribute to an increase in cardiovascular morbidity in OSA patients.
Clinical Analysis of Drug‐Induced Sleep Endoscopy for the OSA Patient
Authors: Golbin‐Hallett Dina , Musgrave Brandon , Yaremchuk Kathleen L. 
Published: September 2014

Objectives:Determine if performing drug‐induced sleep endoscopy (DISE) and trans‐oral robotic surgery (TORS) for the treatment of obstructive sleep apnea (OSA) is associated with improved outcomes and acceptable complication rates when compared to traditional surgical procedures without DISE.Methods:A retrospective, nonrandomized chart review. Patients with OSA who underwent uvulopalatopharyngoplasty (UPPP) in 2011 were compared with a prospective, nonrandomized group of patients with OSA who underwent DISE with other indicated procedures from 2012‐2013 at a major tertiary care center. The pre‐ and postoperative apnea‐hypopnea index (AHI), pre‐ and postoperative Epworth Sleepiness Scale (ESS), and major complication rate were compared.Results:Forty patients underwent UPPP without DISE. These patients showed a significant reduction in AHI –20.1 (P =. 001) and a complication rate of 3% (P =. 001). There was no significant change in ESS –2.2 (P =. 734). Fifty‐nine patients underwent DISE with other indicated procedures. These patients showed a significant reduction in AHI –21.4 (P =. 001) and a complication rate of 34.7% (P =. 001). There was no significant difference in ESS +0.1 (P =. 734) or AHI (P =. 092) between the 2 groups.Conclusions:There was no significant difference in AHI or ESS in patients who underwent UPPP without DISE compared to patients who underwent DISE with other indicated procedures including TORS. Patients who had DISE and TORS surgical interventions for OSA demonstrated an increase in the rate of major complications.
Early Detection of Brain White Matter Damage in Patients with Severe OSA
Authors: Lin Hsin‐Ching , Friedman Michael 
Published: September 2014

Objectives:Obstructive sleep apnea (OSA) is commonly associated with neuropsychological sequelae, presumably induced by brain injury resulting from intermittent hypoxia. Newer magnetic resonance imaging modalities allow a more accurate examination of fiber integrity of the brain microstructure. Diffusion tensor imaging (DTI) is sensitive to the microstructure of brain tissue. This study is to evaluate the integrity of white matter in OSA patients with DTI.Methods:The subjects underwent a polysomnography study to determine the severity of OSA and DTI scans to detect fiber integrity. Fractional anisotropy (FA), a measure of fiber integrity, was derived from the diffusion tensor, resulting in a whole brain FA map. The FA maps were compared using voxel‐based statistics to determine differences between severe OSA and control groups, with age and sex as a covariate. The correlation between FA value and clinical severity was performed.Results:Twenty patients with severe OSA (apnea/hypopnea index, AHI >30/h) and 14 sex‐ and age‐matched healthy volunteers (AHI <5/h) were recruited. The exploratory group‐wise comparison showed that severe OSA patients exhibited reduced FA values in several brain clusters, including the white matter underlying amygdala, superior temporal gyrus, inferior parietal lobule, precuneus, postcentral gyrus, anterior cingulate gyrus, claustrum, insula, basal ganglia, tapetum, and cerebral peduncle compared with controls. The FA values were negatively correlated with clinical disease severity.Conclusions:This study indicates that OSA patients have impaired white matter integrity in vulnerable regions, associated with increased disease severity. The findings likely represent the pathological process of the brain in OSA patients.
The Effect of Upper Airway Surgery on Sleep Quality and Obstructive Sleep Apnea
Authors: Ng Raymond H. W. , Chow Theodore , Fang Chia Yin Joy , Zhang Fan Bruce , Zhang Yu Hai 
Published: September 2014

Objectives:Obstructive sleep apnea (OSA) is a common sleep disorder due primarily to upper airway obstruction. Certain ethnic groups, particularly Chinese, are more susceptible to a severe degree of OSA irrespective of body weight due in part to inherent narrow upper airway anatomy. In this study, we investigated the treatment outcome of combined upper airway surgeries: septoplasty (SP), turbinate reduction (TR), tonsillectomy, and uvulopalatoplasty (UVPP) on OSA in this ethnic group who have clinical identifiable upper airway anatomical obstruction and are unable to tolerate continuous positive airway pressure (CPAP) treatment.Methods:A retrospective study to analyze the effect of either: (1) SP and TR (inferior turbinectomy) only or (2) in combination with UVPP (partial uvulectomy and lateralization of palatal pillars) and standard tonsillectomy, on Chinese patients diagnosed with OSA. Outcome measures were obtained from pre‐ and postoperative polysomnographs (PSG) where sleep parameters, AHI, and oxygen saturation were analyzed.Results:Patients with only SP and TR (n = 20) failed to produce significant changes in sleep efficiency, sleep arousal (either spontaneous or respiratory related), or AHI measures. Conversely, patients with UVPP and tonsillectomy in combination with TR and SP (n = 16) had nearly 50% reduction or more in all categories of AHI (supine, non‐supine, REM, and non‐REM) observed (P <. 002). The degree of respiratory arousals was also reduced in this group.Conclusions:The current study supports a greater role of upper airway and palatal surgery as a primary treatment of choice for this ethnic group with definable upper airway obstruction who failed or are unable to tolerate CPAP treatment.
Expansion Sphincter Pharyngoplasty for Obstructive Sleep Apnea: Outcome Evaluated by Pre‐ and Postoperative Polysomnography
Authors: Pinto Jose A. , Kohler Rodrigo , Hirsch Lina Ana M. , Godoy Luciana B. M. , Martins Laila P. M. , Nunes Heloísa dos S. S. 
Published: September 2014

Objectives:(1) Determine the effectiveness of expansion sphincter pharyngoplasty (ESP) in the treatment of moderate and severe obstructive sleep apnea (OSA). (2) Be able to analyze the effects of the ESP on the sleep stages of patients with moderate and severe OSA. (3) Confirm changes in oxygen saturation after surgery.Methods:A retrospective review of a prospective data set of 20 patients with moderate and severe OSA who underwent ESP. Patients studied were adults with small tonsils, body mass index less than 30 kg/m2, Friedman stage II or III, and type I Fujita. Charts between 2010 to 2014 were reviewed, and preoperative and postoperative polysomnographic values were analyzed.Results:Eighteen patients (90%) undergoing ESP showed some improvement. The surgery was effective in the treatment of severe and moderate obstructive sleep apnea syndrome (OSAS; P <. 001). Patients with severe OSAS had better results with ESP than patients with moderate OSAS (P <. 001). After surgery there were significant changes in sleep stages (P <. 05). Minimum oxygen saturation improved in the moderate and severe OSAS groups.Conclusions:ESP is a valid therapeutic option for the treatment of OSA, and showed better results in severe cases rather than moderate ones. There are variations in the sleep stages that must be considered after this surgery. The surgical technique can bring benefits in oxygen saturation in patients with OSAS.
Hypopharyngeal Airway Surgery for Obstructive Sleep Apnea: Morbidity in the Early Postoperative Period
Authors: Nelson Ryan E. , Carter John M. , Anand Akash G. 
Published: September 2014

Objectives:Determine if hypopharyngeal surgery for obstructive sleep apnea is associated with significant morbidity in the early postoperative period.Methods:Medical records review and retrospective telephone survey of patients who underwent hypopharyngeal surgery for obstructive sleep apnea between November 2012 and September 2013 at a tertiary care facility.Results:Twenty‐two patients underwent hypopharyngeal surgery for obstructive sleep apnea. No patient experienced intraoperative complications, postoperative O2 desaturation <90%, prolonged admission for inadequate pain control, pulmonary edema, or airway compromise requiring re‐intubation. Postoperative complications included 1 episode of nasal hemorrhage, 1 infection requiring hospitalization, and 1 episode of dehydration treated with IV fluids. Twenty‐five percent of patients experienced some degree of postoperative dysphonia, and 87.5% of patients experienced postoperative dysphagia. The average rating for postoperative pharyngeal pain was 3.5 by week 3 and 1.75 by week 4. Most patients described decreased snoring (93.75%), improved feeling of overall health (75%), and increased daytime energy (62.5%). All patients undergoing hypopharyngeal airway surgery were discharged within 23 hours.Conclusions:Hypopharyngeal surgery is a safe and well‐tolerated procedure for the treatment of OSA. Our findings suggest that hypopharyngeal surgery may be performed on an outpatient basis.
Morphometric Analysis of Swallowing Mechanics after Surgery for Obstructive Sleep Apnea
Authors: Pate Mariah B. , Ellis Mark , Reyes Stephanie , Pearson William G. , Brown Jimmy J. 
Published: September 2014

Objectives:Apply a new method of analyzing swallowing biomechanics on postoperative obstructive sleep apnea (OSA) patients using parameters of the modified barium swallow (MBS) imaging.Methods:This novel biometric analysis involved two patients following uvulopalatopharyngoplasty, relocation pharyngoplasty, and base of tongue resection for OSA. Postoperative MBS indicated mild swallowing impairment in both patients. Coordinates mapping 10 anatomical landmarks were collected from every frame of the oropharyngeal swallow using ImageJ software. A canonical variate analysis was performed using MorphoJ software with data pooled by subject (S1, S2) and swallowing phase (OP = oral phase, PP = pharyngeal phase). The Mahalobonis distances (D) of the pooled means from each group were defined. Eigenvectors of shape change in these patients were compared to previously published subjects (non‐surgical) to document changes in swallowing mechanics.Results:Significant differences in shape change were found for all values: OP versus PP of S1(D = 9.2, P <. 0001) and S2 (D = 10.7, P <. 0001); OP of S1 versus S2 (D = 45.4, P <. 0001); PP of S1 versus S2 (D = 39.2, P <. 0001). Eigenvectors indicated reduced pharyngeal shortening and reduced tongue base retraction compared to published data of normal subjects.Conclusions:Tongue base retraction and reduced pharyngeal shortening was noted in this small cohort of patients. These observations are consistent with the postoperative goal of necessary tightening in these areas to avoid collapse. Future controlled studies should be performed to determine whether these changes in swallowing mechanics are specific to surgical interventions or the underlying morphology of OSA patients. This method could potentially be used to quantify the effectiveness of sleep surgical techniques.
A New Philosophy in Surgical Management of Snoring: Tolerability and Effectiveness of the Barbed Roman Blinds Technique
Authors: Mantovani Mario , Rinaldi Vittorio , Salamanca Fabrizio , Carioli Daniela , Torretta Sara , Pignataro Lorenzo 
Published: September 2014

Objectives:Evaluate the tolerability and effectiveness of the Barbed Roman Blinds Technique (BRBT), a new non‐resective procedure in which the tenso‐structural modifications of the fibro‐muscular tissues of the soft palate and the lateral pharyngeal walls, created by means of barbed sutures (QUILL), reduce the collapsibility of the retro‐palatal space.Methods:A prospective study was carried out at the Ospedale Maggiore Policlinico University of Milan, Italy, from September 2012 to June 2103. Twelve snoring patients with mild obstructive sleep apnea syndrome (OSAS; AHI <20) underwent drug‐induced‐sleep‐endoscopy and contextual BRBT under general anesthesia. Patient satisfaction was measured with visual analog scale (VAS), snoring with linear‐analog‐scale (LAS) and snoring‐scale‐score (SSS), daytime sleepiness with Epworth Sleepiness Scale (ESS). Polysomno‐graphy was repeated 6 months postoperatively.Results:Eight males and 4 females, median age 47.5 years (range, 38‐61 months) had no significant postoperative morbidities or complications. The most common complaint was mild swallowing pain with spontaneous resolution within 5 to 7 days. After a median follow‐up of 10 months (range, 15‐8 months), a stable space‐structural remodeling of the velo‐uvulopharyngeal tissues was observed; improvement of snoring was confirmed by reduction in LAS and SSS; high VAS satisfaction values and reduction of ESS and AHI were recorded.Conclusions:BRBT represents an effective, nonresective, reversible, repeatable and well‐tolerated procedure to relieve snoring. Considering the observed reduction of AHI and ESS, the role of BRBT in moderate‐severe OSAS is currently under study.
Prevalence of High Risk for Obstructive Sleep Apnea Using STOP‐Bang Questionnaire in Thai Population
Authors: Charakorn Natamon , Hirunwiwatkul Prakobkiat , Suksamran Apasee , Teerapraipruk Busarakum , Chirakalwasan Naricha 
Published: September 2014

Objectives:Determine the prevalence of high risk for obstructive sleep apnea (OSA) in general Thai population by using the STOP‐Bang questionnaire.Methods:Anonymous survey was conducted in Thailand at Health and Wellness exhibition. The exclusion criterion was age <18 years. The STOP‐Bang questionnaire was used in the survey. This questionnaire consisted of 4 simple yes/no questions: snoring, tiredness, observed apneas, blood pressure, and 4 clinical characteristics which were dichotomized according to specified cutoffs; body mass index >35, age >50 years, neck circumference >40 cm, sex = male. Scores of at least 3 were considered high risk for OSA. Epworth sleepiness scale (ESS) as well as detailed demographic information related to several aspects of sleep was also obtained.Results:The study included 414 Thai adults. The mean age of participants was 51 years old. Of the 414 participants, 305 participants (76%) were classified as high risk for OSA. High risk for OSA group was observed to have more males (88%). The STOP‐Bang yielded a mean score of 3.65. One hundred seventy‐two participants (41%) were noted to have excessive daytime sleepiness (ESS score >10). There was a significant correlation between STOP‐Bang questionnaire score and Epworth sleepiness scale score (P <. 05, r = 0.267).Conclusions:Over 70% of participants were identified as having high risk for OSA based on the STOP‐Bang questionnaire. Considering the serious adverse health and quality of life consequences of OSA, screening for OSA in general populations should be attempted.
The Aesthetic Impact of Modified Extracorporeal Septoplasty
Authors: Aldosari Badi , Disant Francois , Marin Patrick 
Published: September 2014

Objectives:Evaluate the aesthetic impact of our modified septal framework's self‐stabilizing design as a self stabilizing masterpiece.Methods:Retrospective cohort study at an academic tertiary care medical center. A total of 114 patients underwent an extracoporeal septoplasty between 2008 and 2012. Eleven parameters of facial analysis were examined closely on every patient's photograph.Results:Patients had great aesthetic improvement. In fact, a high percentage of patients had a better profile line, central axis, nasal base symmetry, sheen's line, tip symmetry, tip projection, and nasolabial angle. However, we also noticed a widening of the middle third in 27% of the patients and a filling of the nasofrontal angle in 21%. The latter showed a downward trend throughout the years.Conclusions:The modified extracorporeal septoplasty has a positive impact on aesthetic analysis.
Intracapsular Tonsillectomy for Keratosis Pharyngeous: Postoperative Recovery and Surgical Efficacy
Authors: Gaudreau Philip A. , Gessler Eric 
Published: September 2014

Objectives:(1) Compare the postoperative recovery of patients undergoing intracapsular tonsillectomy to subcapsular tonsillectomy for keratosis pharyngeous. (2) Determine the surgical efficacy of intracapsular tonsillectomy in preventing recurrent symptoms in patients with keratosis pharyngis.Methods:A prospective, single‐blinded, randomized controlled trial of adult patients ages 18 years or older diagnosed with keratosis pharyngis between December 2010 and February 2013 was performed. Patients were randomized to receive either intracapsular or subcapsular tonsillectomy with the coblator. Postoperative pain scores and amount of pain medication taken were recorded daily for 2 weeks postoperatively. A 6‐month follow‐up questionnaire was used to assess the efficacy of the procedure based on persistent symptoms.Results:Twenty‐two patients completed the study, with 11 in each group. There was a statistically significant difference in the amount of pain medication consumed on postoperative days 8, 9, and 10, with the intracapsular group consuming less medication (P =. 0293,. 0146,. 035). There was also a statistically significant difference in the recurrence of tonsilloliths at the 6‐month follow‐up point (P =. 0291). Patients who had an intracapsular tonsillectomy had a significantly higher recurrence rate than those patients who had a subcapsular tonsillectomy.Conclusions:In adult patients undergoing tonsillectomy for keratosis pharyngis, an intracapsular, coblation tonsillectomy resulted in lower consumption of pain medication than subcapsular tonsillectomy. However, intracapsular coblation tonsillectomy resulted in a higher rate of recurrence of tonsilloliths. The benefit of decreased pain medication usage in the intracapsular cohort may be offset by the increased likelihood that symptoms will recur.
Updated Systematic Review of Multilevel Surgery for Patients with OSA
Authors: Lin Hsin‐Ching , Friedman Michael 
Published: September 2014

Objectives:Perform an updated systematic review and meta‐analysis to determine the surgical success rate of multilevel upper airway surgery for patients with obstructive sleep apnea syndrome (OSA).Methods:A systematic review was performed to identify English‐language studies that evaluated the treatment of adult OSA patients with multilevel OSA surgery up to May, 2013. We used polysomnography as a metric of treatment success. Articles were included only if the surgery intervention involved at least 2 of the frequently involved anatomic sites: nose, oropharynx and hypopharynx. Seventy‐three studies fit the inclusion criteria and a meta‐analysis was performed to determine the overall success.Results:The meta‐analysis included 3147 subjects with a mean age of 45.0 years. The originally reported success rate in the included literature was 59.8%. A meta‐analysis was performed to redefine the success rate to be consistent with the commonly agreed upon criteria, “a reduction in AHI [apnea‐hypopnea index] of 50% or more and an AHI of less than 20.” The recalculated success rate was 61.4%. Standard meta‐analytic techniques for combining p‐values between studies after weighting for sample size found significant improvements in AI, AHI, %REM sleep, LSAT, snoring visual analog scale, and Epworth Sleepiness Scale.Conclusions:This study shows the significant benefits of multilevel surgery for OSA patients.