The predictive value of polysomnography combined with quality of life for treatment decision of children with habitual snoring related to adenotonsillar hypertrophy.

PURPOSE: Both surgical treatment and non-surgical treatment are suggested by clinicians for children with habitual snoring related to adenotonsillar hypertrophy; However, how should the decision be made remains unclear. The objective of this study was to investigate potential predictors for the treatment decision, i.e., surgical treatment vs wait and see in children with habitual snoring related to adenoidal and/or tonsillar hypertrophy. METHODS: Children with complaints of snoring and/or apnea associated with adenotonsillar hypertrophy who received polysomnography (PSG) monitoring at our Hospital were recruited. After at least 6 months, the subjects were followed up and grouped according to whether or not they had received adenoidectomy and/or tonsillectomy (AT) execution. The heights, weights, as well as the quality of life (assessed using the obstructive sleep apnea-18 (OSA-18) quality of life questionnaire) and baseline PSG of the subjects were recorded and compared. Two logistic regressions were performed to reveal the factors influencing decision-making on conducting AT. RESULTS: A total of 509 children were finally included (345 males and 164 females). Among these children, 287 eventually received AT. Significant differences in age, scores for item 1 and 5 of the OSA-18, apnea-hypopnea index, obstructive apnea index, obstructive apnea-hypopnea index (OAHI), and Lowest arterial oxygen saturation (P < 0.05) were observed between groups. By multivariate logistic regression, the factors that influenced the surgical decision were identified as follows: age < 7 years (P = 0.008: odds ratio [OR] = 1.667, 95% confidence interval [CI] 1.140-2.438), score for item 5 of OSA-18 > 4 points (P = 0.042: OR = 1.489, 95% CI 1.014-2.212) and OAHI > 1/h (P = 0.044: OR = 1.579, 95% CI 1.013-2.463). CONCLUSION: School-age children aged < 7 years, with OAHI > 1/h and mouth breathing scored > 4 points were more likely to receive AT during the disease process and thus require increased attention.

Efficacy of Oral Appliance for Mild, Moderate, and Severe Obstructive Sleep Apnea: A Meta-analysis.

OBJECTIVE: Oral appliances (OA) are the recommended first-line option for mild-to-moderate obstructive sleep apnea (OSA)-hypopnea. However, there is a lack of evidence to compare the effectiveness of OA in different severities of OSA. The purpose of this study was to investigate the therapeutic effects of preferred OA (tongue retention devices [TRD] and mandibular advancement device [MAD]) in different severities of OSA. DATA SOURCES: PubMed/MEDLINE, The Cochrane Library, and Web of Science. REVIEW METHODS: Concentrating on the efficacy of OA, 2 authors searched 3 databases up to November 10, 2022, independently and systematically, following the requirements and steps of the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. RESULTS: Ultimately, 42 studies with 2265 patients met the criteria for inclusion in OA. Overall, the apnea-hypopnea index improved by 48% (5.6), 67% (14.92), and 62% (32.1) in mild, moderate, and severe OSA, respectively. Subgroup analysis showed a significant difference between MAD and TRD efficacy in mild OSA (58% vs 21%). However, no significant difference was seen between MAD and TRD efficacy in moderate (67% vs 66%) and severe OSA (66% vs 51%). There was no significant difference across groups in the Epworth Sleepiness Scale, oxygen desaturation index (ODI), and lowest oxygen saturation (LSAT). CONCLUSION: Overall, both TRD and MAD are effective treatments for moderate and severe OSA. MAD is efficacious in mild OSA, while TRD requires further validation. Furthermore, mild-moderate and severe OSA received similar improvements in sleepiness, ODI, and LSAT. This study complements the evidence for the efficacy of OA.

Upper airway fat tissue distribution in subjects with obstructive sleep apnea and its effect on retropalatal mechanical loads.

OBJECTIVE: To validate the hypothesis that fat tissue accumulation adjacent to the upper airway contributes to a predisposition to obstructive sleep apnea (OSA), irrespective of body mass index (BMI), as well as investigate the effect of the volume of fat tissue on pharyngeal mechanical loads. METHODS: Fourteen subjects and 14 controls were enrolled in this study. Pharyngeal anatomy (the fat tissue volume in the retropalatal region and retroglossal region) were evaluated using magnetic resonance imaging. Whether the subjects had a segmental closing pressure higher than atmospheric pressure was determined by pharyngoscopy under general anesthesia. The difference in fat tissue distribution between subjects with OSA and BMI-matched controls was investigated. Fat tissue distributions in subjects with positive or negative segmental closing pressure were also compared. RESULTS: Significant differences occurred between controls and subjects with OSA in volumes of parapharyngeal fat pad (P = .001), fat of soft palate (P = .01), as well as proportion of the parapharyngeal fat pad to the volume of total lateral pharyngeal soft tissues (P = .004). The volume of pharyngeal cavity, neck circumference, and volume of subcutaneous fat tissues were not significantly different statistically. Volume of fat in soft palate (odds ratio 5.893) and parapharyngeal fat pad in retropalatal and retroglossal region (odds ratios 1.781 and 1.845) were significant predictors of OSA. The volume of fat in the soft palate (P = .003) and parapharyngeal fat pad (P = .002) was higher in participants with positive retropalatal closing pressure; participants with positive retroglossal closing pressure had increased volumes of the tongue (P = .02) and the parapharyngeal fat pad (P = .004). CONCLUSIONS: Patients with OSA have more fat tissue adjacent to the pharyngeal cavity than BMI-matched controls. Fats deposited around the upper airway may contribute to the collapsibility of retropalatal and retroglossal airway in both patients and controls.

Anatomical and computed tomographic analysis of the interaction between the uncinate process and the agger nasi cell.

CONCLUSIONS: The agger nasi cell, together with the postosuperior portion of the uncinate process, was the key that unlocked the frontal recess. OBJECTIVES: To investigate the anatomical interaction between the upper portion of the uncinate process and the agger nasi cell. MATERIALS AND METHODS: Twenty-one skeletal skulls (42 sides) were studied by spiral computed tomography (CT) and endoscopy, and one cadaver head (2 sides) was studied by collodion-embedded sectioning in the coronal plane. RESULTS: The endoscopic view of the entrance of the middle meatus showed the middle part of the uncinate process and the middle part of the middle turbinate fused together as the axilla of the middle meatus. The middle portion of the uncinate process attached to the frontal process of the maxilla in all of the skeletal nasal cavities, as well as the lacrimal bone in 33 sides of the skeletal nasal cavities. On CT scans, the agger nasi cell was present in 38 sides of the skeletal nasal cavities. The agger nasi cell was medially, superiorly and inferiorly bounded by the uncinate process. The superior portion of the uncinate extended into the frontal recess and may insert into the lamina papyracea (33%), skull base (10%), middle turbinate, and a combination of these (57%).

Evaluation of neuromuscular activity in patients with obstructive sleep apnea using chin surface electromyography of polysomnography.

BACKGROUND: It is believed that defects in upper airway neuromuscular control play a role in sleep apnea pathogenesis. Currently, there is no simple and non-invasive method for evaluating neuromuscular activity for the purpose of screening in patients with obstructive sleep apnea. This study was designed to assess the validity of chin surface electromyography of routine polysomnography in evaluating the neuromuscular activity of obstructive sleep apnea subjects and probe the neuromuscular contribution in the pathogenesis of the condition. METHODS: The chin surface electromyography of routine polysomnography during normal breathing and obstructive apnea were quantified in 36 male patients with obstructive sleep apnea. The change of chin surface electromyography from normal breathing to obstructive apnea was expressed as the percent compensated electromyography value, where the percent compensated electromyography value = (normal breath surface electromyography - apnea surface electromyography)/normal breath surface electromyography, and the percent compensated electromyography values among subjects were compared. The relationship between sleep apnea related parameters and the percent compensated electromyography value was examined. RESULTS: The percent compensated electromyography value of the subjects varied from 1% to 90% and had a significant positive correlation with apnea hypopnea index (R(2) = 0.382, P < 0.001). CONCLUSIONS: Recording and analyzing chin surface electromyography by routine polysomnography is a valid way of screening the neuromuscular activity in patients with obstructive sleep apnea. The neuromuscular contribution is different among subjects with obstructive sleep apnea.

A modified septoplasty with three high tension lines resection.

UNLABELLED: The modified septoplasty with three tension lines resection is an effective and well-tolerated procedure, which can improve the objective and subjective outcomes, and provide a good approach that is applicable for various septal deviations, especially caudal deviation. OBJECTIVES: According to the biomechanics of the septal deviation, a modified septoplasty with three high tension lines resection was redefined. The purpose of this study was to review the surgical technique and objective and subjective outcomes. METHODS: A retrospective review was conducted to identify patients undergoing septoplasty between 2005 and 2006 at Beijing Tongren Hospital. The records were reviewed for demographic data, intraoperative technique, surgical indications, objective and subjective outcomes, and postoperative complications. RESULTS: A total of 54 patients were identified. The follow-up period ranged from 6 to 12 months. Indications for septoplasty included nasal obstruction (40.7%) and access (59.3%). The data showed that both the objective and subjective outcomes improved after septoplasty. Complications included transient dental pain/hypesthesia (5.6%), synechiae formation (7.4%), epistaxis (1.9%), septal hematoma (3.7%), asymptomatic septal perforation (0%), and nasal deformity (0%).

[Measurement of exhaled nitric oxide in healthy Chinese].

OBJECTIVE: To obtain the normal values of nitric oxide (NO) exhaled through nose and mouth in healthy Chinese adults by measuring exhaled NO and analyzing the influencing factors. METHODS: Eighty healthy Chinese adults were recruited, including 20 males and 60 females. The age ranged from 18 to 44 years old. Chemiluminescence analyzer (NIOX) was used to obtain the values of exhaled NO through nose and mouth. The relativity between NO and gender, age, height, body mass index, time, ambient NO were analyzed with Multiple linear regression and correlation. RESULTS: Exhaled NO values were (17+/-8)x10(-9) and correlated significantly with height. Regression equation: Y (exhaled nitric oxide)=-58.524+0.457X (height, cm), t=-2.985, P<0.01. Transnasal NO values were (819+/-211)x10(-9) and correlated significantly with age and gender. Regression equation: Y (nasal nitric oxide)=760.245+9.417X1(age)-111.222X2(gender), t=5.188, P<0.01. CONCLUSIONS: Exhaled NO normal values were 17x10(-9) and Transnasal NO normal values were 819x10(-9). Exhaled NO correlated positively with height. Transnasal NO correlated positively with age and negatively with gender.

[Use of endoscopic placement of laryngeal stent combined with mucosal suturing of vocal fold for the treatment of laryngeal web].

OBJECTIVE: To investigate the effects of laryngeal stent combined with vocal fold mucosal suture for treating laryngeal web. METHODS: A retrospective study performed, 21 laryngeal web cases were included in this study. The web causes were previous vocal fold surgery for benign lesions in 8 cases, previous laryngeal surgery for recurrent papilloma in 6 cases, laryngeal trauma in 6 cases, and congenital web in 1 case. Fifteen adults received glottic silastic sheet keels placement with vocal fold suture, another 2 adults and 4 children only had vocal fold suture, the above procedures were performed with laryngeal endoscopy. RESULTS: Among all patients, good glottis shape was achieved and good voice maintained, 6 months to 3 years follow-up showed open airway without restenosis. 15 adults who had both keels placement and vocal cord suture tolerated the keel well. Keel removal under direct laryngoscopy was performed 3-4 weeks after surgery. A normal triangular shaped glottis anterior commissure anatomy was restored in 14 patients and 2-3 mm residual webbing was found in 1 patient (who had laryngofissure history). 2-3 mm residual webbing was found in 4 children who only had endoscopic vocal fold suture. After receiving endoscopic vocal fold suture, 2 adults who was found to have 2-3 mm normal mucosal membrane in anterior commissure during surgery, restored normal vocal cord shape. CONCLUSIONS: The study shows that silastic keel placement combined with vocal fold mucosal suture was successful for treating laryngeal webs cases. Mucosal suturing of vocal fold may decrease or eliminate raw surface exposure and it is useful in the management of pediatric laryngeal webs and webs with normal mucosal membrane in anterior commissure. The potential benefits of those procedures are in avoiding long-term glottic stenting, laryngofissure, and tracheotomy.

[Preoperative overnight airway pressure measurement for predicting the outcome of revised uvulopalatopharyngoplasty].

OBJECTIVE: The distribution of upper airway obstruction sites can be identified quantitatively and dynamically with continuous airway pressure measurements in obstructive sleep apnea hypopnea syndrome ( OSAHS) patients. Its value as a clinical predictor for the outcome of revised uvulopalatopharyngoplasty was evaluated. METHODS: The upper airway obstruction sites (transpalatal level, tongue base or hypolarynx level) were determined preoperatively with overnight upper airway pressure monitoring and concurrent polysomnography (PSG). Of one's total amount of obstructive events, the proportion of apnea/hypopnea events located at Transpalatal level was quantified as contribution of transpalatal obstruction. Of all OSAHS patients, 26 males and 1 female underwent revised uvulopalatopharyngoplasty (2 had same stage transpalatal advancement pharyngoplasty) and had follow-up PSG 6. 33 +/- 0.84 months after surgery. The relationship of transpalatal obstruction proportion, age, tonsil size and body mass index (BMI) and the reduction in apnoea hypopnea index (AHI) was analyzed. RESULTS: The AHI (times/hr) of 27 subjects decreased from 63.9 +/- 20.7 to 28.4 +/- 25.4. The response rate was 51.9% (defined as AHI reduction over 50%). Correlation between the transpalatal obstruction proportion and the AHI reduction percentage was significant (r = 0.609), so was the degree of the tonsil size (r = 0.511). The proportion of tongue base level obstruction showed a negative correlation for the AHI reduction. Patients with oropharynx obstruction percentage > or = 70% had a success rate of 90% and all patients with oropharynx obstruction percentage <60% responded poorly to the operation. The regression model showed distribution of obstructive sites, along with tonsil size and other PSG parameters could predict 66.7% of the postoperative AHI of transpalatal level surgery (F = 6.701, P = 0.001) . CONCLUSIONS: Contribution of transpalatal level obstruction has significant predictive value to the outcome of transpalatal level surgery in OSAHS patients.

[Clinical study of uvulopalatopharyngoplasty treatment for middle degree of obstructive sleep apnea syndromes].

OBJECTIVE: In order to investigate the treatment of obstructive sleep apnea syndrome (OSAS) METHOD: The improved uvulopalatopharyngoplasty (UPPP) operations were performed on 64 cases. RESULT: The clinical results showed that 70. Thirty-one percent of the operated patients somewhat improved and 29. Seventy percent unimproved. CONCLUSION: UPPP is one of the effective methods to treat OSAS, especially for OSAS with stricture in pharyngeal cavity. It has less damage, less operative complications and so on.

[Prevention of complications during paralaryngeal space neoplasms surgery].

OBJECTIVE: To explore the prevention of complications during the the paralaryngeal space (PPS) neoplasms surgery. METHOD: A retrospect study was carried out from 41 patients, suffering from paralaryngeal space neoplasms and recerving surgery from 1990 to 2002. The surgical procedures included oral approach in 6 cases, parotid approach in 6 cases, cervical approach in 25 cases, cervical approach with mandibular swing in 2 cases and lateral skull-base approach 2 in cases. Eight cases got the tracheodectomy during the operations. The tumor in 37 cases were resected throughly, except for 4 cases with partial resection. RESULT: The patients were followed up for 11 months to 6 years. The surgical complications consists of surgical cavity infections in 2 cases, a massive bleeding in 1 case with huge nerve sheath tumor and permanent nerves damage in 7 cases, including Horner's syndrome (2 cases) and nerves damage (5 cases), such as VII, IX, X and XI. Six cases relapsed: 1 case with benign tumor through oral approach and 5 cases with malignant neoplasms. CONCLUSION: Familiarity with PPS anatomy, preoperational evaluation in detail, proper surgery approach and perfect treatment during the operation are vital important to avoid the complications in PPS neoplasms.