Prevalence of respiratory epithelial adenomatoid hamartomas (REAH) associated with nasal polyposis: an epidemiological study - how to diagnose

Abstract Objectives: To highlight the prevalence of respiratory epithelial adenomatoid hamartomas in the olfactory cleft of patients with nasal polyposis. To demonstrate characteristics indicative of hamartoma on the CT scans of paranasal sinuses during surgery and in histopathological exams. Methods: Cross-sectional study carried out in Hospital das Clínicas da UFMG and Núcleo de Otorrino BH. We performed 114 nasal endoscopic surgeries for polyposis, between February 2015 and November 2019. We assessed the olfactory cleft width in all preoperative CT scans. Upon seeing an indication of hamartoma on the CT scan, we took a tissue sample from the olfactory cleft during the surgery and sent for histopathological exam. We referred the samples to a pathologist experienced in the anatomopathological diagnosis of respiratory epithelial adenomatoid hamartomas. Results: Of the 114 patients with polyposis, 54 (47.4%) had olfactory cleft enlargement and, 100% of them had tissue with a dense and hardened polypoid aspect, with a slight cerebri-form appearance in this region during the surgery. Histology confirmed a respiratory epithelial adenomatoid hamartoma. Conclusion: This observation suggests that the presence of hamartomas in polyposis is common, but underdiagnosed. Level of evidence: Step 3 (Level 3).

Prevalence of respiratory epithelial adenomatoid hamartomas (REAH) associated with nasal polyposis: an epidemiological study - how to diagnose.

OBJECTIVES: To highlight the prevalence of respiratory epithelial adenomatoid hamartomas in the olfactory cleft of patients with nasal polyposis. To demonstrate characteristics indicative of hamartoma on the CT scans of paranasal sinuses during surgery and in histopathological exams. METHODS: Cross-sectional study carried out in Hospital das Clínicas da UFMG and Núcleo de Otorrino BH. We performed 114 nasal endoscopic surgeries for polyposis, between February 2015 and November 2019. We assessed the olfactory cleft width in all preoperative CT scans. Upon seeing an indication of hamartoma on the CT scan, we took a tissue sample from the olfactory cleft during the surgery and sent for histopathological exam. We referred the samples to a pathologist experienced in the anatomopathological diagnosis of respiratory epithelial adenomatoid hamartomas. RESULTS: Of the 114 patients with polyposis, 54 (47.4%) had olfactory cleft enlargement and, 100% of them had tissue with a dense and hardened polypoid aspect, with a slight cerebriform appearance in this region during the surgery. Histology confirmed a respiratory epithelial adenomatoid hamartoma. CONCLUSION: This observation suggests that the presence of hamartomas in polyposis is common, but underdiagnosed. LEVEL OF EVIDENCE: Step 3 (Level 3).

Análise de desempenho do questionário PosaST como ferramenta de rastreio para Síndrome da Apneia Obstrutiva do Sono (SAOS) em crianças / Performance analysis of the PosaST questionnaire as screening tool for Obstructive Sleep Apnea syndrome (OSA) in children

Introdução: a síndrome da apneia obstrutiva do sono (SAOS) pediátrica atinge de 0,7 a 3% desta população, com importantes impactos secundários. Entretanto, o principal exame para seu diagnóstico, a polissonografia (PSG), é de pouca disponibilidade, principalmente no contexto nacional e de saúde pública. Torna-se necessária, portanto a avaliação de ferramentas alternativas, como os questionários, quanto à sua capacidade de rastreio dessa condição. Objetivo: Avaliar o desempenho do questionário Pediatric Obstructive Sleep Apnea Screening Tool (PosaST) como ferramenta diagnóstica de rastreio de SAOS na população pediátrica. Adicionalmente, determinar se outras variáveis, obtidas a partir de preenchimento de questionários pré-PSG, e dos resultados da própria PSG, se comportam distintamente entre os grupos de pacientes com e sem SAOS. Métodos: pais de 122 pacientes de três a 12 anos, referidos a um Laboratório do sono para realização de PSG responderam o questionário PosaST e questionário pré-PSG. O escore cumulativo do PosaST foi obtido a partir de seus escores individuais para cada pergunta, e comparado com os resultados da PSG. Além de teste de correlação entre o índice de apneia e hipopneia obstrutivo (IAHO) e o escore cumulativo do PosaST, foram então determinadas: curva receiver operating characteristic (ROC), sensibilidade, especificidade, valor preditivo positivo (VPP) e valor preditivo negativo (VPN) para o escore cumulativo do PosaST, tanto para diagnóstico de SAOS (IAHO ≥ 1,5 eventos/h de tempo total de sono ­ TTS), quanto para diagnóstico de quadros moderados e graves dessa enfermidade (IAHO ≥ 5 eventos/h de TTS). Variáveis clínicas provenientes do questionário pré-PSG, do escore individual e cumulativo do PosaST e da polissonografia, foram avaliadas por estudos de associação nos grupos com e sem SAOS. Resultados: as curvas ROC obtidas mostraram baixa área sobre a curva, refletindo desempenho ruim da ferramenta PosaST tanto para diagnóstico de SAOS, quanto para diagnóstico de casos moderados/graves. Valores de sensibilidade, especificidade, VPP e VPN corroboraram esta conclusão. Foi identificada correlação significante, mas fraca, entre IAHO e escore cumulativo do PosaST. Entre as demais variáveis pesquisadas, apenas atraso de desempenho escolar, uso de medicações, saturação de oxigênio (SpO2) mínima e média, tempo com SpO2<90%, índices de dessaturação e despertares se comportaram de maneira diferente entre os grupos. Conclusão: apesar de se apresentar como uma ferramenta prática, o PosaST não mostrou boa capacidade para rastrear pacientes pediátricos com SAOS ou com SAOS moderada/grave. A SAOS associou-se a atraso de desempenho escolar, menores valores de SpO2 média e mínima e maiores valores de tempo com SpO2<90%, índices de dessaturação e despertares.

Introduction: Pediatric obstructive sleep apnea syndrome (OSA) affects from 0,7 to 3% of patients in this population, with considerable secondary impact. Nevertheless, the main tool for its diagnosis, the polysomnography (PSG) exam, is not widely available, especially in national context and public health care system. Thus, it becomes imperative the evaluation of alternative tools, such as questionnaires, as its capacity to screen this condition. Objective: To evaluate the Pediatric Obstructive Sleep Apnea Screening Tool (PosaST) questionnaire performance as a screening diagnostic tool among the pediatric population. Additionally, to determine if other variables, obtained through completion of pre-PSG questionnaires and PSG results, behave differently between groups of patients with and without OSA. Methods: Parents of 122 patients, from three to 12 years old, referred to a Sleep Laboratory for polysomnography exam, answered the PosaST and the pre-PSG questionnaires. The PosaST's cumulative score was acquired through its individual scores for each question, and compared to PSG results. In addition to the correlation test between Obstructive Apnea Hypopnea Index (OAHI) and PosaST's cumulative score, it was determined: receiver operating characteristic (ROC) curve, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for PosaST's cumulative score as its capacity to diagnose OSA (OAHI ≥ 1,5 events/h of total sleep time ­ TST) and to diagnose moderate and severe OSA cases (OAHI ≥ 5 events/h of TST). Clinical variables, from pre-PSG questionnaire, PosaST's individual and cumulative escores, and polysomnography, were analyzed through association studies within OSA and non-OSA groups Results: ROC curves obtained showed low area under the curve, reflecting the tool's poor performance to diagnose OSA and moderate and severe OSA cases. Sensitivity, specificity, PPV and NPV values agreed to this assessment. A valid, but weak correlation between OAHI and PosaST's cumulative score was identified. Among other studied clinical variables, only impairment in school performance, use of medications, minimal and average oxygen saturation (SpO2), time with SpO2<90%, desaturation and arousals index were presented differently in the evaluated groups. Conclusion: Although PosaST presents itself as a practical tool, it doesn't show a reasonable capacity to screen OSA, or moderate/severe OSA patients in the pediatric population. OSA was associated to impairment in school performance, descreased values of minimal and average oxygen saturation (SpO2), e increased values of time with SpO2<90%, desaturation and arousals index.