In-Laboratory Polysomnography Worsens Obstructive Sleep Apnea by Changing Body Position Compared to Home Testing.

(1) Background: Home sleep apnea testing, known as polysomnography type 3 (PSG3), underestimates respiratory events in comparison with in-laboratory polysomnography type 1 (PSG1). Without head electrodes for scoring sleep and arousal, in a home environment, patients feel unfettered and move their bodies more naturally. Adopting a natural position may decrease obstructive sleep apnea (OSA) severity in PSG3, independently of missing hypopneas associated with arousals. (2) Methods: Patients with suspected OSA performed PSG1 and PSG3 in a randomized sequence. We performed an additional analysis, called reduced polysomnography, in which we blindly reassessed all PSG1 tests to remove electroencephalographic electrodes, electrooculogram, and surface electromyography data to estimate the impact of not scoring sleep and arousal-based hypopneas on the test results. A difference of 15 or more in the apnea-hypopnea index (AHI) between tests was deemed clinically relevant. We compared the group of patients with and without clinically relevant differences between lab and home tests (3) Results: As expected, by not scoring sleep, there was a decrease in OSA severity in the lab test, similar to the home test results. The group of patients with clinically relevant differences between lab and home tests presented more severe OSA in the lab compared to the other group (mean AHI, 42.5 vs. 20.2 events/h, p = 0.002), and this difference disappeared in the home test. There was no difference between groups in the shift of OSA severity by abolishing sleep scoring in the lab. However, by comparing lab and home tests, there were greater variations in supine AHI and time spent in the supine position in the group with a clinically relevant difference, either with or without scoring sleep, showing an impact of the site of the test on body position during sleep. These variations presented as a marked increase or decrease in supine outcomes according to the site of the test, with no particular trend. (4) Conclusions: In-lab polysomnography may artificially increase OSA severity in a subset of patients by inducing marked changes in body position compared to home tests. The location of the sleep test seems to interfere with the evaluation of patients with more severe OSA.

Apneia do sono: ha diferencas entre laringectomias verticais ou horizontais? / Obstructive sleep apnea: is there a difference between vertical and horizontal laryngectomy?

As laringectomias parciais são utilizadas no tratamento do câncer de laringe. A alteração estrutural na via aérea superior decorrente da cirurgia pode predispor à Apneia Obstrutiva do Sono. OBJETIVO: Avaliar comparativamente os pacientes submetidos a laringectomias parciais horizontais e verticais quanto a prevalência e gravidade da apneia do sono e determinar possível papel para a espirometria neste grupo. MÉTODO: Pesquisa em prontuários. Avaliação dos pacientes por meio de anamnese, exame otorrinolaringológico, polissonografia, espirometria, videonasofibroscopia. Estudo tipo coorte transversal. RESULTADOS: 92,3% do total de 14 pacientes estudados apresentavam Apneia Obstrutiva do Sono. O índice de apneia/hipopneia médio foi significativamente maior entre os pacientes submetidos a laringectomias verticais (36,9) do que a horizontais (11,2), assim como a média da saturação mínima da oxi-hemoglobina, que foi de 85,9 no grupo da laringectomia horizontal e de 84,3 no grupo da laringectomia vertical. A espirometria demonstrou obstrução extratorácica alta em 100% dos pacientes com diagnóstico de Apneia Obstrutiva do Sono. CONCLUSÃO: Observamos alta incidência de apneia do sono em pacientes submetidos a laringectomias parciais. A doença tende a ser mais grave no grupo submetido a laringectomias verticais. A espirometria parece ser exame interessante para determinar pacientes de risco para diagnóstico de AOS nesta situação. NCT01157286. .

Partial laryngectomy is used in the treatment of laryngeal cancer. Structural alterations of the upper airway arising from partial laryngectomy can cause obstructive sleep apnea (OSA). OBJECTIVE: To compare the prevalence and severity of OSA in patients submitted to horizontal and vertical partial laryngectomy and assess the role of spirometry for these patients. METHOD: Cross-sectional clinical study with individuals offered partial laryngectomy. The included patients were assessed through interview, upper airway endoscopy, polysomnography, and spirometry. RESULTS: Fourteen patients were evaluated and 92.3% were found to have OSA. The apnea-hypopnea index was significantly higher among patients submitted to vertical laryngectomy (mean = 36.9) when compared to subjects offered horizontal laryngectomy (mean = 11.2). The mean minimum oxyhemoglobin saturation was 85.9 in the horizontal laryngectomy group and 84.3 in the vertical laryngectomy group. Spirometry identified extrathoracic upper airway obstruction in all patients with OSA. CONCLUSION: The studied population had a high incidence of obstructive sleep apnea. OSA was more severe in patients offered vertical laryngectomy than in the individuals submitted to horizontal laryngectomy. Spirometry seems to be useful in the detection of cases of suspected OSA, as it suggests the presence of extrathoracic upper airway obstruction. .

Obstructive sleep apnea: is there a difference between vertical and horizontal laryngectomy?

UNLABELLED: Partial laryngectomy is used in the treatment of laryngeal cancer. Structural alterations of the upper airway arising from partial laryngectomy can cause obstructive sleep apnea (OSA). OBJECTIVE: To compare the prevalence and severity of OSA in patients submitted to horizontal and vertical partial laryngectomy and assess the role of spirometry for these patients. METHOD: Cross-sectional clinical study with individuals offered partial laryngectomy. The included patients were assessed through interview, upper airway endoscopy, polysomnography, and spirometry. RESULTS: Fourteen patients were evaluated and 92.3% were found to have OSA. The apnea-hypopnea index was significantly higher among patients submitted to vertical laryngectomy (mean = 36.9) when compared to subjects offered horizontal laryngectomy (mean = 11.2). The mean minimum oxyhemoglobin saturation was 85.9 in the horizontal laryngectomy group and 84.3 in the vertical laryngectomy group. Spirometry identified extrathoracic upper airway obstruction in all patients with OSA. CONCLUSION: The studied population had a high incidence of obstructive sleep apnea. OSA was more severe in patients offered vertical laryngectomy than in the individuals submitted to horizontal laryngectomy. Spirometry seems to be useful in the detection of cases of suspected OSA, as it suggests the presence of extrathoracic upper airway obstruction.

Colesteatoma primário de meato acústico externo bilateral / Primary cholesteatoma of the bilateral external acoustic meatus

Introdução: O colesteatoma de meato acústico externo é uma patologia rara. A maioria das séries na literatura descreve casos secundários, com poucos relatos de colesteatoma primário. Caracteriza-se pela erosão da porção óssea do meato acústico externo por proliferação de tecido escamoso adjacente. Objetivo: Relatar um caso raro de colesteatoma primário de meato acústico externo bilateral. Relato do Caso: Paciente de 20 anos, sexo feminino, com otalgia há 3 anos, associada à hipoacusia e otorreia à esquerda. Sem história prévia de patologias otológicas. À otoscopia, observava-se erosão bilateral do meato acústico externo com grande quantidade de debris epidérmicos. A tomografia computadorizada evidenciou colesteatoma de meato acústico externo bilateral, sendo a paciente submetida à timpanomastoidectomia radical modificada à direita. Comentários Finais: O colesteatoma primário de meato acústico externo é uma patologia rara, fazendo parte do diagnóstico diferencial de otalgia e otorreia crônicas. A avaliação da sua extensão deve ser feita com tomografia computadorizada e o tratamento de eleição é a cirurgia.

Introduction: The cholesteatoma of the external acoustic meatus is an uncommon pathology. Most series in the literature describe secondary cases, with a few reports of primary cholesteatoma. It is characterized by the erosion of the external acoustic meatus bone portion by proliferation of the adjacent squamous tissue. Objective: To report an uncommon case of primary cholesteatoma of the bilateral external acoustic meatus. Case Report: Female patients aged 20 years old with ear ache for 3 years, associated to hypacusis and otorrhea to the left. Without a previous history of otologic pathologies. Upon otoscopy, there could be noticed bilateral erosion from the external acoustic meatus with a large amount of epidermal debris. The computed tomography confirmed cholesteatoma of the bilateral external acoustic meatus and the patient was submitted to modified radical tympanomastoidectomy to the right. Final Comments: The primary cholesteatoma of the external acoustic meatus is an uncommon pathology that is part of the differential diagnosis of chronic otalgia and otorrhea. The evaluation of its extension must be done with computed tomography and surgery is the choice treatment.