Short-Term Continuous Positive Air Pressure Treatment: Effects on Quality of Life and Sleep in Patients with Obstructive Sleep Apnea.

Background and Objectives: The aim of this study was to evaluate short-term continuous positive air pressure (CPAP) treatment for health-related quality of life (HRQL) in patients with obstructive sleep apnea. Materials and Methods: Our subjects were 18−65 years old, diagnosed with moderate-to-severe obstructive sleep apnea and treated with CPAP between January 2020 and June 2021 in Hospital of Lithuanian University of Health Sciences Kaunas clinics. All the patients completed the Epworth Sleepiness Scale (ESS), the 36-Item Short Form Health Survey (SF-36), the and Pittsburgh Sleep Quality Index (PSQI) before and after 3 months of treatment. Polysomnography was also repeated. Statistical analyses were performed using SPSS 27.0 software. The value of p < 0.05 was considered as statistically significant. Results: The active-treatment group comprised 17 subjects with a mean age of 51.9 ± 8.9 years. The total SF-36 questionnaire score improved from 499.8 ± 122.3 to 589.6 ± 124.7 (p = 0.012). The SF-36 role limitations due to emotional problems (p = 0.021), energy (fatigue) (p = 0.035), and general health (p = 0.042) domains score significantly improved after CPAP treatment for 3 months. The PSQI mean score at baseline was 12.6 ± 2.9 and in the post-treatment group, it was −5.5 ± 2.3 (p = 0.001). The ESS also changed significantly from a pretreatment mean score of 10.9 ± 5.7 to −5.3 ± 3.2 (p = 0.002) after 3 months. Conclusions: Improvement in HRQL is seen even after a short treatment period with CPAP. Questionnaires are a good tool to evaluate CPAP treatment efficacy.

Cross-cultural adaptation and validation of Lithuanian-NOSE scale.

PURPOSE: To evaluate validity and reliability of Lithuanian version of Nasal Obstruction Symptom Evaluation Scale (L-NOSE), designed for the assessment of nasal obstruction. METHODS: Cross-cultural adaptation of L-NOSE was accomplished according to generally accepted methodology. L- NOSE was tested for its reliability, validity, and responsiveness in the group of 50 septoplasty patients and 100 healthy volunteers' controls. RESULTS: L- NOSE showed good internal consistency (Cronbach's alpha coefficient 0.796 for test, 0.791 for retest, 0.792 for post-operative group, and 0.817 for control group) scores and high test-retest reliability (r = 0.94, p < 0.01) scores. In patients' group, positive moderate correlations between L-NOSE scores and Sino-nasal Outcome Test-22 logically similar domain scores were found, thus indicating good convergent construct validity. L-NOSE scores for control subjects were generally lower than for patients with nasal obstruction (p < 0.001), thereby indicating good discriminant validity of questionnaire. The exploratory factor analysis confirmed one-factor structure of questionnaire. The component matrix of L-NOSE ranged from 0.667 to 0.781 (KMO = 0.754, p < 0.0001). The mean L-NOSE score improved from 58.4 ± 18.2 points to 11.1 ± 9.5 points after septoplasty (p < 0.0001), indicating good responsiveness of questionnaire. CONCLUSION: The L-NOSE questionnaire is a valid instrument with satisfactory reliability, validity, and responsiveness.

Lithuanian version of nasolacrimal duct obstruction symptom scoring questionnaire. Cross-cultural adaptation and validation. Short- and long-term results.

OBJECTIVES: The objective of this study was to perform translation, cross-cultural adaptation and validation of the Lithuanian version of specific nasolacrimal duct obstruction symptom scoring (NLDO-SS) questionnaire and to evaluate short- and long-term results of endoscopic endonasal dacryocystorhinostomy (EN-DCRS) procedure. DESIGN, SETTING, PARTICIPANTS: Permission for questionnaire translation, cross-cultural adaptation and validation was obtained from the authors of the original questionnaire. Translation, validation and cross-cultural adaptation were carried out according to generally accepted methodology. Validation study of the Lithuanian version of NLDO-SS (L-NLDO-SS) was performed, and short- and long-term results of EN-DCRS procedure were evaluated according to symptoms. In total, 44 patients were evaluated 2 weeks before the surgical intervention, a day before the surgery and 41 patients 2 months after the surgery, and again 10 months later. MAIN OUTCOME MEASURES: We analysed the internal consistency and test-retest reliability of the L-NLDO-SS questionnaire. Cronbach's alpha was used to represent and evaluate internal consistency for ordinal responses. Validity was assessed by comparing scores between a control group of volunteers without NLDO and the NLDO group using Mann-Whitney test. To test the limiting score on which the sensitivity and specificity curves cross in identifying patients with NLDO, receiver operating characteristic (ROC) curve analysis was used. The pre- and post-operative scores were compared using the paired t-test. RESULTS: The results showed an acceptable internal consistency of L-NLDO-SS questionnaire, with Cronbach's alpha-.73 in the initial test group and .71 in the retest group. Pearson's correlation coefficient was .94 (P < .001), revealing good correlation between the initial scores and the retest scores. Our sample of healthy individuals had a mean L-NLDO-SS score of 11.42 (±12.69) points, and patients being scheduled for EN-DCRS had a mean L-NLDO-SS score of 27.45 (±9.81) points. Post-operatively mean L-NLDO-SS scores improved from 27.45 (±9.81) points to 4.45 (±6.29) points in the short term and to 5.83 (±4.17) in the long term, demonstrating the statistically significant responsiveness of the instrument over both timescales. CONCLUSIONS: Lithuanian version of NLDO-SS questionnaire is a valid instrument for assessing patients with NLDO in the Lithuanian population. It demonstrated good internal consistency, reproducibility, validity and responsiveness.

Efficacy of radiofrequency treatment of the soft palate for patients with mild to moderate obstructive sleep apnea hypopnea syndrome: treatment protocol with nine lesions to the soft palate.

PURPOSE: The study aimed at assessing the efficacy and safety of a radiofrequency treatment (RFT) protocol with nine lesions to the soft palate in the treatment of mild to moderate obstructive sleep apnea hypopnea syndrome (OSAHS). METHODS: Twenty-eight mild to moderate OSAHS patients underwent two sessions of RFT (CelonLab ENT system) at the palatal level within the interval from 6 to 8 weeks. Nine lesions (power setting of 10 W) were made per session. The baseline and posttreatment polysomnography and clinical tests battery consisting of visual analogue scales (VAS), Sleep Apnea Quality of Life Index (SAQLI), Beck Depression Inventory--second edition (BDI-II), and Epworth sleepiness scale (ESS) were applied to assess the RFT outcomes. RESULTS: Mild to moderate OSAHS patients demonstrated statistically significantly reduced posttreatment mean VAS values for most of the OSAHS-related complaints. A significant improvement in sleepiness (ESS score 6.7 ± 3.7 vs 8.5 ± 4.1, p < 0.01), depressivity (BDI-II score 7.5 ± 6.5 vs 13.1 ± 11.7, p < 0.01), and health-related quality of life (SAQLI score 5.3 ± 0.8 vs 4.7 ± 0.9, p < 0.01) was observed after the RFT. The mean AHI decreased from 13.7 ± 5.9 to 8.3 ± 4.9 points (p < 0.01) in the entire group of patients. According to Sher's criteria of success, 17 out of 28 (60.7 %) patients improved after RFT. No major complications were noted with RFT. CONCLUSIONS: RFT protocol with nine lesions to the soft palate seems to be an effective and safe treatment modality associated with low morbidity in selected mild to moderate OSAHS patients.

Controlled trial of combined radiofrequency-assisted uvulopalatoplasty in the treatment of snoring and mild to moderate OSAS (pilot study).

PURPOSE: The aim of this study was to assess the efficacy of radiofrequency treatment (RFT) of the soft palate and combined radiofrequency-assisted uvulopalatoplasty (RF-UPP) in the treatment of snoring and mild to moderate obstructive sleep apnea/hypopnea syndrome (OSAHS). METHODS: In the study group consisting of 32 snoring and mild to moderate OSAHS patients with excessive soft tissue of the soft palate or uvula, 13 patients underwent RFT of the soft palate and 19 patients underwent combined RF-UPP. The baseline and posttreatment polysomnography and clinical test battery consisting of Visual Analogue Scales (VAS), Lithuanian version of Sleep Apnea Quality of Life Index (SAQLI-LT), Spielberg's Trait-State Anxiety Inventory, Beck Depression Inventory-second edition (BDI-II), and Epworth Sleepiness Scale were applied to assess the treatment outcomes. RESULTS: After a short-term follow-up of 2 to 3 months, the group of the RFT patients showed improvement in mean VAS snoring and SAQLI-LT scores, while the group of RF-UPP patients showed statistically significantly improvement in mean apnea-hypopnea index (AHI) (12.51 ± 7.66 vs. 7.88 ± 6.05, p < 0.05, ß = 0.107), SAQLI-LT, and BDI-II scores. The group of RF-UPP patients had superior and statistically significant improvement compared to the RFT alone patients with regard to mean AHI (effect size 4.63 ± 4.65 vs. 0.95 ± 4.83, p < 0.05) and SAQLI-LT (effect size 0.75 ± 0.59 vs. 0.33 ± 0.40, p < 0.05) scores. CONCLUSIONS: Combined RF-UPP showed to be effective in the treatment of snoring and mild to moderate OSAS overcoming the RFT alone.

Translation, cross-cultural adaptation, and validation of the sino-nasal outcome test (SNOT)-22 for Lithuanian patients.

The objective of this study was to perform translation, cross-cultural adaptation, and validation of the SNOT-22 in the Lithuanian language. This is a prospective case-control study. The study was conducted at the University clinic. The sino-nasal outcome test 22 (SNOT-22) was translated into the Lithuanian language; the pilot study involved 34 patients, the test-retest group consisted of 34 patients with chronic rhinosinusitis (CRS), and the control group of 115 patients with no CRS complaints; 36 patients were evaluated before surgery and 3 months after surgery. The results showed a good internal correlation with Cronbach's alpha-0.89 in the initial test, and 0.93 in the retest; both values suggesting good internal consistency within the SNOT-22. Pearson's correlation coefficient was 0.72 (p < 0.001), revealing good correlation between the initial scores and the retests scores. Our sample of healthy individuals had a median score of 12 points, and the instrument was capable of differentiating between the healthy and the patient group, demonstrating its validity (p < 0.0001). The statistically significant reduction in the post-operative scores, vis-à-vis pre-operative values, demonstrates the responsiveness of the instrument. The minimally important difference was 13 points in the SNOT-22 score. The Lithuanian version of the SNOT-22 is a valid instrument for assessing patients with CRS. It demonstrated good internal consistency, reproducibility, validity, and responsiveness.

Peculiarities of clinical profile of snoring and mild to moderate obstructive sleep apnea-hypopnea syndrome patients.

PURPOSE: The purpose of this study is to perform comprehensive evaluation of the snoring and mild to moderate obstructive sleep apnea-hypopnea syndrome (OSAHS) patients for their anatomical, functional, and psychoemotional clinical properties. METHODS: Seventy-four snoring patients, aged 24 to 64 (mean 41.83 ± 11.01) years underwent full-night polysomnography, nasopharyngoscopy, and Mueller maneuver. Clinical tests battery consisting of visual analogue scales (VAS) scales, Lithuanian version of Sleep Apnea Quality of Life Index (SAQLI-LT), Spielberg's State-Trait Anxiety Inventory (STAI), Beck Depression Inventory-Second Edition (BDI-II), and Epworth Sleepiness Scale (ESS) were applied to assess their distinctive clinical properties. RESULTS: The total group of snoring and mild to moderate OSAHS patients presented with considerably enlarged VAS snoring and daytime sleepiness scores (mean 66.32 ± 19.07 and 35.03 ± 27.83 points), mild BDI-II scores (mean 10.96 ± 9.42 points), and moderate trait anxiety scores (mean 41.51 ± 8.62 points). All the scores of daytime complaints measured with the VAS correlated statistically significantly with the mean scores of the ESS, SAQLI-LT, trait anxiety, and BDI-II. Both groups, of snoring and mild to moderate OSAHS patients, indicated similar intensity of the major complaints according to the VAS, same as similar BDI-II, STAI, and SAQLI-LT scores. A higher Friedman's score of palatal tonsils was found in the group of snoring patients, comparing to that of the group of mild to moderate OSAHS patients (p < 0.05). CONCLUSIONS: Snoring and mild to moderate OSAHS patients have resemblances in their distinctive anatomical and clinical properties. This group of the patients revealed mild depression and moderate trait anxiety scores when measured with the BDI-II and STAI, which correlated significantly with the severity of the patients' daytime complaints measured with the VAS.

Changes in emotional state of bed partners of snoring and obstructive sleep apnea patients following radiofrequency tissue ablation: a pilot study.

PURPOSE: To test the hypothesis that obstructive sleep apnea/hypopnea syndrome (OSAHS) and snoring affect not only the patients but also their bed partners, resulting in increased severity of symptoms of depression and sleepiness that may improve after the patients receive radiofrequency tissue ablation (RFTA) treatment. METHODS: Thirty-six snoring and/or OSAHS patients from 24 to 63 years of age (mean age 41.67 +/- 9.86 years) underwent full-night polysomnography (PSG) and two sessions of RFTA at palatal or palatal and tongue base levels. Follow-up PSG was carried out within the period of 2-3 months after the second RFTA session. The baseline and posttreatment clinical tests battery consisting of Spielberg's Trait-State Anxiety Inventory, Beck Depression Inventory-Second Edition (BDI-II), and Epworth Sleepiness Scale (ESS) were applied to assess the changes in emotional state of study group patient's bed partners. RESULTS: Mean apnea/hypopnea index decreased from 13.16 +/- 10.76 preoperatively to 10.69 +/- 8.28 postoperatively (p = 0.043) for the entire group of the patients. A statistically significant decrease of the mean BDI-II scores (12.69 +/- 7.66 preoperatively to 9.17 +/- 6.88 postoperatively, p < 0.005) for the entire group of the patients' bed partners was observed. There was no statistically significant difference between pre- and posttreatment mean daytime sleepiness scores in both OSAHS and in simple snoring patients' bed partners when measured with ESS. CONCLUSIONS: Based on present study results, we conclude that RFTA therapy results in improved depression scores for the bed partners of snoring and OSAHS patients during a short follow-up period, as measured with BDI-II.

Changes in emotional state of snoring and obstructive sleep apnea patients following radiofrequency tissue ablation.

A total of 37 primary snoring and obstructive sleep apnea hypopnea syndrome (OSAHS) patients were treated with two sessions of radiofrequency tissue ablation (RFTA) to assess the relationship among RFTA and sleepiness, anxiety and depression in patients with OSAHS. Patients' sleepiness was rated according to the Epworth sleepiness scale (ESS), anxiety--on Spielberg's trait-state anxiety inventory scale and depression degree--with Beck depression inventory-second edition scale and the patients' major complaints were evaluated using visual analog scales before and after the treatment. A remarkable decrease in patients' complaints, sleepiness and depression after RFTA was observed. The ESS mean score decreased from 9.3 +/- 3.4 to 7.14 +/- 3.2 points (P < 0.05) and Beck depression index mean value decreased from 14.2 +/- 10.8 to 8.7 +/- 7.6 points (P < 0.05), respectively. RFTA is a treatment of choice for snoring and mild to moderate OSAHS. Reduction of sleepiness and depression was statistically significant after RFTA.

Glottal function index questionnaire for screening of pediatric dysphonia.

OBJECTIVE: to assess the diagnostic value of Lithuanian version of Glottal Function Index (GFI-LT) questionnaire in pediatric dysphonia screening. METHODS: The GFI-LT was completed by 82 children (7-16 years old): 41 patients with voice disorders (patients group) and 41 healthy subjects (control group). Auditory-perceptual evaluation of voice was performed using the Grade Roughness Breathiness (GRB) protocol. Acoustic voice analysis was accomplished for F0, SDF0, jitter, shimmer and NNE using Dr. Speech, Tiger Elemetrics software. To evaluate the diagnostic accuracy differentiating normal and dysphonic voice, the receiver operating characteristic statistics were used. RESULTS: Perceptually dysphonia was revealed in all children of the patients group. Grade I (65.9%) was the most prevalent (p > 0.05). No dysphonia was detected in the control group. Acoustic voice analysis revealed statistically significantly (p < 0.001) deteriorated all acoustic voice parameters in patients' group comparing to control group. Statistically significant (p < 0.05) strong or moderate correlations were found between the GFI-LT, auditory-perceptual rating and all acoustic voice parameters of the patients group. The strongest correlations were observed between GFI-LT and G (r = 0.70), R (r = 0.69), jitter (r = 0.56) and SDF0 (r = 0.56). No statistically significant correlations between GFI-LT and children' age or gender were found (p > 0.05). The GFI-LT cut-off score of ≥3.0 was associated with excellent test accuracy (AUC = 0.961) distinguishing children with voice disorders from healthy controls, resulting in a balance between sensitivity and specificity (95.1% vs 85.4%). CONCLUSION: GFI-LT is considered to be a valid and reliable tool for self-assessment and screening of voice disorders in children.

Psychometric properties of the Lithuanian version of Sleep Apnea Quality of Life Index (a pilot study).

OBJECTIVE: To arrange and test for its psychometric properties Lithuanian version of Sleep Apnea Quality of Life Index and assess quality of life among snoring and obstructive sleep apnea patients before and after the treatment. MATERIAL AND METHODS: Cross-cultural adaptation of Lithuanian version of Calgary Sleep Apnea Quality of Life Index was accomplished according to generally accepted methodology. In total, 36 (29 males and 7 females) patients (mean age, 41.1+/-9.7 years) suffering from socially disturbing snoring and obstructive sleep apnea were included into the study. All patients underwent complete full-night polysomnography (mean apnea/hypopnea index, 12.7+/-11.2) and were treated with two sessions of radiofrequency tissue ablation at the palatal and tong base (if it was necessary) levels. Lithuanian version of the Calgary Sleep Apnea Quality of Life Index was presented before the treatment with radiofrequency tissue ablation and in the period of 2 to 3 months after the treatment. Thirty-five patients repeated the same questionnaire after three weeks to assess the reliability of scores. RESULTS: The Cronbach's a coefficients of internal reliability were above the standard (0.7 for groups) in all subdomains and domains. Test-retest correlation coefficients for each domain (ranged from 0.92 to 0.94) were statistically significant (P<0.0001). Lithuanian version of the questionnaire was found to be responsive to clinical change. A statistically significant difference in the mean Sleep Apnea Quality of Life Index scores in the study group patients before and after the surgery was found in all daily functioning subdomains and social interactions domains. CONCLUSIONS: Overall, the results of the present pilot study demonstrate that the Lithuanian version of Sleep Apnea Quality of Life Index is applicable for clinical purposes.