Hearing evaluation with ABR in pediatric patients with celiac disease.

BACKGROUND/AIMS: Celiac disease (CD) is an autoimmune and genetic disease that is triggered by gluten intolerance. We aimed to investigate whether Celiac disease have any effect on Auditory Brainstem Response (ABR) waves compare to a healthy control group, and present its association with sensorineural hearing loss (SNHL). MATERIALS AND METHODS: Thirty-eight patients aged 2 to 16 years old were included in the study. The patients had confirmed diagnosis of Celiac disease through duodenal biopsies and transglutaminase Antibody (Ab) (+). The control group consisted of 18 children aged 3 to 17 years old who were all admitted to the pediatric gastroenterology department due to complaints of constipation and transglutaminase Ab (-).All children underwent Auditory-Brain-Stem-Evoked Responses (ABR). The data were gathered using click stimulus at 10/s frequency 90dB HL. RESULTS: The results of ABR examination did not show any difference between the patient group and control group as regards the latency of the waves I, III, V. No difference was observed between the two groups in the interpeak latecies I-III, I-V and III-V. None of the patients was observed to have clinical hearing loss. DISCUSSION: The exact pathogenesis of neurological damages observed in Celiac disease is still unknown. Humoral immune mechanisms are the most frequently attributed cause. CONCLUSION: Although no significant difference was found in hearing values between the study group and healthy control group, there is a need for further research on this subject.

Robotic Tongue-Base Resection Combined With Tongue-Base Suspension for Obstructive Sleep Apnea.

OBJECTIVES/HYPOTHESIS: Our primary objective was to evaluate the feasibility, morbidity, and efficacy of transoral robotic surgery (TORS) tongue-base resection (TBR) combined with tongue-base suspension (TBS) for obstructive sleep apnea (OSA) with tongue-base collapse. Our secondary objective included evaluation of factors influencing treatment success. STUDY DESIGN: Single-arm, prospective, observational cohort study. METHODS: Patients were eligible if they had moderate-to-severe OSA (apnea hypopnea index [AHI] > 15) or positional OSA, had a tongue-base collapse and glossoptosis identified by drug-induced sleep endoscopy (DISE), and failed continuous positive airway pressure. All patients underwent TORS-TBR combined with TBS. Additionally, concomitant epiglottoplasty, uvulopalatopharyngoplasty, or expansion pharyngoplasty were performed based on DISE findings. RESULTS: In total, 64 patients were enrolled in the trial. The mean age was 45.9 years, mean body mass index was 30.5 kg/m2 , and mean AHI was 41.7 events/hour. The mean robotic surgical time, total volume of tongue-base tissue removed, and the length of hospital stay were 21.4 minutes, 15.16 mL, and 6.5 days, respectively. Postoperatively, almost all polysomnographic metrics improved significantly (AHI = 41.72 vs. 18.82 events/hour, lowest oxygen saturation = 80.43% vs. 85.14%, Epworth Sleepiness Scale = 10.49 vs. 4.09). The procedure provided an overall success rate of 75%, with minor morbidity. All patients experienced varying degrees of temporary lingual edema postoperatively. Tracheotomy was not required for any patient. Although no independent predictor of treatment success was determined, patients with more severe disease tend to exhibit lower response to the treatment. CONCLUSIONS: TORS-TBR combined with TBS is a feasible, safe, and efficient procedure for OSA with tongue-base collapse. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:2285-2291, 2020.

Hyalinizing Clear Cell Carcinoma of the Maxilla.

Hyalinizing clear cell carcinoma (HCCC) is a rare low-grade salivary gland tumor with distinctive clear cell morphology, accounting for < 1% of all salivary gland tumors. In the majority of cases, the tumor originates typically from the minor salivary glands in the oral cavity. A total of 155 cases of HCCCs from head and neck region have been reported in the literature until 2017, of which only 16 are of maxillary origin. Due to its low incidence, there is no clear consensus on prognostic factors and optimal treatment strategies yet. In this paper, a new case of HCCC of the maxilla is presented and its clinical and histopathological features are discussed.

Robotic resection of lingual thyroglossal duct cyst in an infant.

Thyroglossal duct cysts (TDCs) are the most common congenital midline neck masses. Lingual TDC is a rare variant that emerges as an isolated cyst at the tongue base. Unlike conventional procedures aiming removal of cyst, duct, and hyoid bone via open surgical access, a transoral cystectomy is mostly sufficient in cases with lingual TDC. We present a case describing a 3-month-old infant patient with lingual TDC who was successfully treated with transoral robotic surgery. The cyst wall was completely excised with no complications or obvious bleeding occurred. The operating time was 10 min. He had an uneventful postoperative course. Six months postoperatively, he is free of symptoms with no evidence of recurrence. Surgical treatment of lingual TDC in an infant is possible with transoral robotic approach and minimal risk of complication. Further studies are strongly needed to confirm the safety of robotic surgery in pediatric population.

Impact of age on intermittent hypoxia in obstructive sleep apnea: a propensity-matched analysis.

PURPOSE: To determine independent relationship of aging with chronic intermittent hypoxia, we compared hypoxia-related polysomnographic variables of geriatric patients (aged ≥ 65 years) with an apnea-hypopnea index (AHI)-, gender-, body mass index (BMI)-, and neck circumference-matched cohort of non-geriatric patients. METHODS: The study was conducted using clinical and polysomnographic data of 1280 consecutive patients who underwent complete polysomnographic evaluation for suspected sleep-disordered breathing (SDB) at a single sleep disorder center. A propensity score-matched analysis was performed to obtain matched cohorts of geriatric and non-geriatric patients, which resulted in successful matching of 168 patients from each group. RESULTS: Study groups were comparable for gender (P = 0.999), BMI (P = 0.940), neck circumference (P = 0.969), AHI (P = 0.935), and severity of SDB (P = 0.089). The oximetric variables representing the duration of chronic intermittent hypoxia such as mean (P = 0.001), the longest (P = 0.001) and total apnea durations (P = 0.003), mean (P = 0.001) and the longest hypopnea durations (P = 0.001), and total sleep time with oxygen saturation below 90% (P = 0.008) were significantly higher in the geriatric patients as compared with younger adults. Geriatric patients had significantly lower minimum (P = 0.013) and mean oxygen saturation (P = 0.001) than non-geriatric patients. CONCLUSIONS: The study provides evidence that elderly patients exhibit more severe and deeper nocturnal intermittent hypoxia than the younger adults, independent of severity of obstructive sleep apnea, BMI, gender, and neck circumference. Hypoxia-related polysomnographic variables in geriatric patients may in fact reflect a physiological aging process rather than the severity of a SDB.

Can Statistical Machine Learning Algorithms Help for Classification of Obstructive Sleep Apnea Severity to Optimal Utilization of Polysomnography Resources?

OBJECTIVES: The goal of this study is to evaluate the results of machine learning methods for the classification of OSA severity of patients with suspected sleep disorder breathing as normal, mild, moderate and severe based on non-polysomnographic variables: 1) clinical data, 2) symptoms and 3) physical examination. METHODS: In order to produce classification models for OSA severity, five different machine learning methods (Bayesian network, Decision Tree, Random Forest, Neural Networks and Logistic Regression) were trained while relevant variables and their relationships were derived empirically from observed data. Each model was trained and evaluated using 10-fold cross-validation and to evaluate classification performances of all methods, true positive rate (TPR), false positive rate (FPR), Positive Predictive Value (PPV), F measure and Area Under Receiver Operating Characteristics curve (ROC-AUC) were used. RESULTS: Results of 10-fold cross validated tests with different variable settings promisingly indicated that the OSA severity of suspected OSA patients can be classified, using non-polysomnographic features, with 0.71 true positive rate as the highest and, 0.15 false positive rate as the lowest, respectively. Moreover, the test results of different variables settings revealed that the accuracy of the classification models was significantly improved when physical examination variables were added to the model. CONCLUSIONS: Study results showed that machine learning methods can be used to estimate the probabilities of no, mild, moderate, and severe obstructive sleep apnea and such approaches may improve accurate initial OSA screening and help referring only the suspected moderate or severe OSA patients to sleep laboratories for the expensive tests.

Intraoperative assessment of laryngeal malignancy using elastic light single-scattering spectroscopy: A pilot study.

OBJECTIVES/HYPOTHESIS: The elastic light single-scattering spectroscopy (ELSSS) system is a new tool for the real-time diagnosis of cancerous lesions. In the current study, we have employed ELSSS to investigate its ability in differentiation between normal and cancerous larynx tissues ex vivo. STUDY DESIGN: Basic science study in assessment of laryngeal malignancy using spectroscopy. METHODS: ELSSS spectra of the larynx tissue were acquired using a single-fiber optical probe. Ex vivo spectroscopic measurements were acquired on 95 laryngeal lesions of 40 patients. Average slopes of the spectra in the wavelength range of 450 to 750 nm were calculated. The signs of the spectral slopes were positive for benign and negative for cancerous larynx tissues. Histopathology results were used as a gold standard to define sensitivity and specificity. RESULTS: The ELSSS system correctly defined 38 out of 41 malignant tissues as cancerous; three of them were misclassified as benign. All benign tissues were correctly classified. Moderate, severely dysplastic, and malignant tissues were correctly classified as cancerous. The system could not classify mild dysplastic tissues either benign or cancerous, whereas nearly half of them were classified as benign and the other half as malignant. The signs of the spectral slopes were used as a discrimination parameter between benign and cancerous (moderate, severely dysplastic, and malignant) lesions with a sensitivity and specificity of 94% and 100%, respectively. CONCLUSIONS: The ELSSS system has the potential to be used as an adjunctive tool in the diagnosis of cancerous laryngeal tissues in real time and noninvasively. This new diagnostic technique may reduce the number of negative biopsies. LEVEL OF EVIDENCE: NA Laryngoscope, 127:611-615, 2017.

Chronic Invasive Nongranulomatous Fungal Rhinosinusitis in Immunocompetent Individuals.

Chronic invasive nongranulomatous fungal rhinosinusitis is a well-described but uncommon type of fungal rhinosinusitis (FRS). While the prevalence of chronic FRS is 0.11% in healthy individuals, only 1.3% of them are in nongranulomatous invasive nature. The majority of the cases in the literature have been reported from developing countries mostly located in the tropical regions, as typically occurring in the background of diabetes mellitus or corticosteroid treatment. The current paper reports four consecutive cases, who were diagnosed within a short period of six months at a single center of a country located outside the tropical climate zone. None of the patients had a comorbid disease that may cause immune suppression or a history of drug use. The only risk factor that may have a role in development of chronic invasive nongranulomatous FRS was that all of our patients were people working in greenhouse farming. Three cases underwent endoscopic sinus surgery, and one case underwent surgery with both endoscopic and external approaches. Systemic antifungal therapy was initiated in all cases in the postoperative period with voriconazole 200 mg orally twice a day. All patients achieved a complete clinical remission. Chronic invasive nongranulomatous FRS should be kept in mind in the presence of long-standing nonspecific sinonasal symptoms in immunocompetent individuals, particularly with a history of working in greenhouse farming.

Estimation of cardiovascular disease from polysomnographic parameters in sleep-disordered breathing.

We aimed to illustrate the causal relationships between cardiovascular diseases (CVDs) and various polysomnographic variables, and to develop a CVD estimation model from these variables in a population referred for assessment of possible sleep-disordered breathing (SDB). Clinical and polysomnographic data of 1162 consecutive patients with suspected SDB whose comorbidity status was known, were reviewed, retrospectively. Variable selection was performed in two steps using univariate analysis and tenfold cross validation information gain analysis. The resulting set of variables with an average merit value (m) of >0.005 was considered to be causal factors contributing to the CVDs, and used in Bayesian network models for providing estimations. Of the 1162 patients, 234 had CVDs (20.1 %). In total, 28 parameters were evaluated for variable selection. Of those, 19 were found to be associated with CVDs. Age was the most effective attribute in estimating CVD (m = 0.051), followed by total sleep time with oxygen saturation <90 % (m = 0.021). Some other important variables were apnea-hypopnea index during non-rapid eye movement (m = 0.018), lowest oxygen saturation (m = 0.018), body mass index (m = 0.016), total apnea duration (m = 0.014), mean apnea duration (m = 0.014), longest apnea duration (m = 0.013), and severity of SDB (m = 0.012). The modeling process resulted in a final model, with 76.9 % sensitivity, 96.2 % specificity, and 92.6 % negative predictive value, consisting of all selected variables. The study provides evidence that the estimation of CVDs from polysomnographic parameters is possible with high predictive performance using Bayesian network analysis.

The relationship between the duration of obstructive respiratory events and outcomes of multilevel upper airway surgery in patients with obstructive sleep apnea.

We aimed to examine whether the duration of respiratory events and related oximetric values are associated with outcomes of multilevel upper airway surgery in patients with moderate-severe obstructive sleep apnea (OSA). The records of patients with a preoperative apnea-hypopnea index (AHI) >15 events/h, who underwent uvulopharyngopalatoplasty plus tongue base suspension with or without septoplasty between 2012 and 2014, were reviewed retrospectively. If the postoperative 6th month AHI was <20 events/h with at least a 50 % reduction from preoperative rates, the outcome of surgery was regarded as successful, otherwise, as failure. To calculate factors predictive of surgical outcomes, a receiver operating characteristic (ROC) analysis was performed. Logistic regression analyses were utilized to obtain the Odds ratio (OR) and 95 % confidential interval (CI). In total, 82 patients were enrolled in the study. Sixty-one patients (74.4 %) met the success criteria. The mean obstructive apnea duration (OAD) was the sole variable with a significant and satisfactory area under the curve (AUC) value [AUC (95 % CI) = 0.719 (0.597-0.842), p = 0.003]. The cutoff value was found to be 26.75 s with 71.4 % sensitivity, 72.1 % specificity, 88.0 % positive predictive value, and 46.9 % negative predictive value. Univariate analysis revealed an association between surgical failure and mean OAD > 26.75 s, total apnea duration, lowest SaO2, mean SaO2, mean O2 desaturation, and oxygen desaturation index, although only mean OAD > 26.75 s remained to be an independent predictor for unfavorable outcome after adjustment for other confounders in multivariate analysis [OR (95 % CI) = 3.92 (1.08-14.17), p = 0.041]. The current study suggests that OSA patients having longer OAD are in the risk of having surgical failure.

The influence of multilevel upper airway surgery on CPAP tolerance in non-responders to obstructive sleep apnea surgery.

The aim of this study was to evaluate the influence of multilevel upper airway surgery on subsequent continuous positive airway pressure (CPAP) use and tolerance in patients with moderate to severe obstructive sleep apnea (OSA). The study cohort enrolled 67 consecutive patients, who underwent septoplasty plus modified uvulopharyngopalatoplasty (mUPPP) with or without modified tongue base suspension (mTBS) due to CPAP intolerance, and who had residual OSA requiring CPAP therapy [non-responders to surgery, apnea-hypopnea index (AHI) >15 events/h] that had been confirmed by control polysomnography at the sixth month postoperatively. A questionnaire including questions on postoperative CPAP use, problems faced during CPAP use after the surgery, change in OSA symptoms, and satisfaction with the surgery was designed, and filled through interviews. Seventeen (25.4 %) patients had septoplasty plus mUPPP and 50 (74.6 %) had septoplasty plus mUPPP combined with mTBS. Postoperatively, mean AHI (45.00 ± 19.76 vs. 36.60 ± 18.34), Epworth sleepiness scale (ESS) score (18.00 ± 4.45 vs. 13.00 ± 4.72), oxygen desaturation index (ODI) (48.98 ± 16.73 vs. 37.81 ± 17.03), and optimal CPAP level (11.80 ± 1.40 vs. 8.96 ± 1.20) were decreased (p < 0.001 for all parameters). Fifty-nine percent of patients reported that they fairly satisfied with the surgery and 49.2 % reported that their symptoms were completely resolved. While none of the cases could tolerate CPAP before surgery, almost half (47.8 %) of the cases used CPAP without problems postoperatively. Postoperative CPAP users had significantly higher postoperative AHI (p = 0.001), supine AHI (p = 0.009), ESS (p = 0.019), and ODI (p = 0.014), and significantly lower postoperative minimum O2 saturation (p = 0.001) compared with non-users. Multilevel upper airway surgery with less invasive techniques may improve CPAP tolerance in well-selected patients.

A systematic review of tongue base suspension techniques as an isolated procedure or combined with uvulopalatopharyngoplasty in obstructive sleep apnea.

We aimed to evaluate existing research into the effectiveness and safety of two tongue base suspension (TBS) techniques (Repose(®) system and modified TBS) with or without uvulopalatopharyngoplasty (UPPP) in obstructive sleep apnea. The literature review was performed using PubMed database. Searched terms used included the keywords "sleep apnea", "surgery", "tongue", "tongue base", "suspension", "Repose", "uvulopalatopharyngoplasty", and "hypopharynx". Levels of evidences and grades of recommendations were determined according to the hierarchy proposed by Oxford Centre for Evidence-based Medicine. Seven studies including 113 patients met the eligibility criteria for TBS as a stand-alone procedure. Four of seven studies including 62 patients used the Repose(®), and three studies including 51 patients used the modified TBS. The success rates were higher in the studies that used modified technique (74.5 %) than those that used the Repose(®) (25.8 %), (p < 0.001). Ten studies including 300 patients met the eligibility criteria for TBS combined with UPPP. Seven of ten studies including 176 patients used the Repose(®), and three studies including 124 patients used the modified TBS. The success rates in this group were similar between the modified TBS (73.4 %) and Repose(®) (67.6 %), (p = 0.341). When aggregate data of 413 patients were compared, the modified TBS was found to be associated with significantly higher success rates (73.7 vs. 56.7 %, p < 0.001). The evidence supports primarily grade C recommendations for the benefits of both techniques with or without UPPP; although there is a trend toward improved outcome with modified technique.

Pediatric sinonasal rhabdomyosarcoma: A case report.

Pediatric sinonasal rhabdomyosarcoma (PSR) is a rare condition, with a limited number of previously reported cases. It is an aggressive malignancy associated with poor outcomes, and no consensus has been reached on the optimal therapeutic strategy. The present study reported the case of embryonal PSR in a 2-year old girl, presenting with unilateral nasal obstruction and a polypoid mass protruding from the left nasal cavity. The pediatric patient was initially treated with surgical resection, followed by adjuvant chemotherapy containing vincristine (1.5 mg/m2, weekly) and actinomycin-D (1.5 mg/m2, three times weekly). On the 10th month of follow-up, tumor recurrence was detected and a salvage surgery was performed, while the same chemotherapy regimen was resumed. Following the first cycle of chemotherapy, the patient developed a fungal bronchopneumonia and succumbed due to disease progression, acute respiratory distress syndrome and septic shock 12 months after diagnosis.

Internal Jugular Vein Thrombosis following Oropharyngeal Infection.

Internal jugular vein thrombosis (IJVT) is a rare condition which may lead to life-threatening complications such as sepsis and pulmonary embolism. Prolonged central venous catheterization, intravenous (IV) drug use, trauma, and radiotherapy are the most frequent causes of the IJVT. IJVT that develops after the oropharyngeal infection is a quite rare situation today. In this paper, a 37-year-old woman was presented; swelling occurred on her neck after acute tonsillitis and she was diagnosed with IJVT through Doppler ultrasonography and magnetic resonance imaging and managed without complications. Early diagnosis and conservative treatment with broad-spectrum IV antibiotics and anticoagulant agents have a critical importance for the prevention of fatal complications.

Spindle Cell Carcinoma of the Larynx: A Confusing Diagnosis for the Pathologist and Clinician.

Laryngeal spindle cell carcinoma (SpCC) is an uncommon subtype of squamous cell carcinoma which represents 0.5% of all laryngeal squamous cell carcinomas. It is a biphasic tumor consisting of the combination of a malignant mesenchymal spindle cell component and a squamous cell component that includes dysplasia, carcinoma in situ, or invasive carcinoma. Although it has aggressive biological features, the probability of making a diagnosis in the early stages is high as it often leads to obstructive symptoms in the early period. Due to its low incidence, there is no clear consensus on prognostic factors and optimal treatment strategies yet. In this paper, a 60-year-old laryngeal SpCC case that was effectively treated with wide local excision followed by adjuvant radiotherapy was presented with the literature.

The impact of modified tongue base suspension on CPAP levels in patients with severe OSA.

The aim of this study was to evaluate the effects of modified tongue base suspension (mTBS) procedure on continuous positive airway pressure (CPAP) levels in patients with severe obstructive sleep apnea (OSA). From November 2011 to December 2012, a total of 31 patients with severe OSA who underwent mTBS were included into this prospective case series with planned data collection. Prior to surgery, all the patients were subjected to a polysomnography (PSG) and CPAP titration on two separate nights. Following the surgery, patients were subjected to a control PSG and CPAP titration at the sixth month of follow-up period. The preoperative and postoperative mean apnea hypopnea index (AHI), CPAP titration values, AHI during CPAP use and amount of sleeping time with CPAP were compared. Median age was 48 years (range 31-66), and most patients were male (87.0 %). Postoperative mean AHI (44.73 ± 17.05 vs. 19.96 ± 19.52), optimal CPAP value (12.64 ± 1.60 vs. 8.00 ± 1.77) and AHI during CPAP use (3.79 ± 1.78 vs. 2.25 ± 1.81) were decreased, and the amount of sleeping time with CPAP (5.29 ± 0.84 vs. 6.52 ± 0.89) was increased significantly (p < 0.001 for all parameters). The surgery was considered to be successful when 50 % reduction in the mean AHI and/or the decrease of AHI below 20/h were obtained. A total of 24 patients (77.4 %) met the surgical success criteria. The mTBS is a safe and feasible procedure with favorable effects on CPAP levels in patients with severe OSA.

Factors influencing sleep time with oxygen saturation below 90% in sleep-disordered breathing.

OBJECTIVES/HYPOTHESIS: To determine factors influencing sleep time with oxygen saturation below 90% (ST90) in a population referred to a tertiary sleep center for assessment of possible sleep-disordered breathing (SDB). STUDY DESIGN: Retrospective review of demographic and polysomnographic data of 731 consecutive patients with suspected SDB. METHODS: Bivariate correlation analyses were performed, and Spearman rho coefficients were calculated. Variables with a marginal association with ST90 (P < .05) in the bivariate analysis were included into the multiple regression analysis. RESULTS: The distributions of SDB were as follows: normal/simple snoring, 18.2%; mild obstructive sleep apnea (OSA), 25.6%; moderate OSA, 17.4%; and severe OSA, 38.9%. The univariate analysis revealed a significant correlation between ST90 and age (r = 0.204), body mass index (BMI) (r = 0.440), arousal index (r = 0.754), apnea-hypopnea index (AHI) (r = 0.761), mean oxygen saturation (SaO2) (r = -0.506), and mean O2 desaturation (r = 0.858) (P < .001 for all parameters). In multiple regression analysis, age (P < .001), BMI (P = .040), male gender (P = .001), AHI (P < .001), mean SaO2 (P < .001), and mean O2 desaturation (P < .001) were found to be independent parameters influencing ST90. Furthermore, these parameters explained a significant proportion of variance in ST90 (R(2) = 0.794, F (6, 729) = 464.65, P < .001). Although there was a strong correlation between AHI and ST90 (r = 0.76, P < .001), a large variation of ST90 values was observed, especially within the severe OSA group. CONCLUSIONS: The study results provide supporting evidence that patients with similar AHI may have quite different values of ST90, and thereby hypoxia. The stratification of patients with OSA according to AHI combined with ST90 may allow better identification of prognostic information.

Predicting the outcome of modified tongue base suspension combined with uvulopalatopharyngoplasty.

The purpose of this study was to investigate the relationship between various polysomnographic variables and the success of modified tongue base suspension combined with uvulopharyngopalatoplasty in patients with severe obstructive sleep apnea (OSA). A total of 90 patients who had apnea hypopnea index (AHI) >30 and had both oropharyngeal and hypopharyngeal obstruction were included in this prospective case series with planned data collection. All patients were assessed preoperatively and at the sixth postoperative month by polysomnography. The surgery was considered to be successful when a ≥50% reduction in the mean AHI to a final AHI of <20/h was obtained. Multiple logistic regression analyses were performed to determine the impact of variables on the surgical success. A total of 67 patients (74.4%) met the surgical success criteria. The univariate analysis revealed a relationship between success and AHI (P = 0.001), obstructive apnea duration (P = 0.001), sleep time with oxygen saturation below 90% (ST90) (P = 0.004), minimum O2 saturation (P = 0.0001), mean O2 saturation (P = 0.011), mean O2 desaturation (P = 0.0001), and oxygen desaturation index (P = 0.001). However, ST90 [OR (95% CI) = 1.40 (1.04-1.89), P = 0.023] was the only independent parameter predicting the surgical success in multivariate analysis. The ROC analysis revealed that the ST90 value of ≤36 min was the best cutoff value with 96.97% sensitivity (CI 89.5-99.6), 95.83% specificity (CI 78.9-99.9), 98.5% PPV (CI 91.6-100.0), and 92.0% NPV (CI 74.0-99.0). The stratification of patients with severe OSA according to the ST90 may allow better identification of patients in whom surgical success is probable.