Cardiopulmonary coupling analysis: changes before and after treatment with a mandibular advancement device.

PURPOSE: The aim of this study is to evaluate the changes of sleep quality in patients using a mandibular advancement device (MAD) for obstructive sleep apnea (OSA) based upon cardiopulmonary coupling (CPC). METHODS: A total of 52 patients (mean age 53.7±9.6 years, range 33-74 years) were included in this study. Of them, there were 47 males (90.4%). All subjects were diagnosed with OSA after in-laboratory full-night polysomnography and reevaluated after 3-month use of a MAD. At baseline, apnea-hypopnea index (AHI) was 33.6±17.0, Epworth sleepiness scale was 10.5±4.8, and Pittsburgh sleep quality index was 5.8±2.8. The CPC parameters were extracted from single-lead electrocardiography of polysomnography. We compared CPC parameters at baseline with those after 3-month use of a MAD. RESULTS: All respiratory indices improved with the use of MAD. However, there were no differences in the sleep architectures except N3 sleep (3.7±4.3 to 6.9±6.4%, p<0.001). The CPC parameters showed a significant improvement with the use of MAD. Low-frequency coupling (59.5±16.1 to 47.7±14.8%, p<0.001) and elevated low-frequency coupling (44.6±18.4 to 32.6±15.7%, p<0.001) significantly decreased. High-frequency coupling (28.6±16.0 to 36.5±15.7%, p=0.004) and very low frequency coupling (11.7±7.2 to 15.3±6.6%, p=0.028) significantly increased. The change of AHI significantly correlated with changes of the CPC parameters: negatively correlated with high-frequency coupling change (r=-0.572, p<0.001) and positively correlated with low-frequency and elevated low-frequency coupling changes (r=0.604 and 0.497, respectively; p<0.001 in both). However, the changes of Epworth sleepiness scale and Pittsburgh sleep quality index after MAD therapy showed no significant correlation with the changes in the CPC parameters. CONCLUSIONS: To our knowledge, this is the first study to evaluate the quality of sleep in patients using a MAD for their OSA based upon CPC analysis. Low-frequency coupling decreased as AHI improved, while high-frequency coupling increased as AHI improved. The CPC parameters showed that the sleep quality was improved by MAD therapy.

Modified technique for endoscopic endonasal reduction of medial orbital wall fracture using a resorbable panel.

PURPOSE: To describe a modified technique using resorbable panel for endoscopic endonasal reduction of medial orbital wall fracture. METHODS: A prospective, small interventional case series involving 2 patients with medial orbital wall fractures that were treated with the modified technique. Postoperatively, patients were evaluated for visual acuity, enophthalmos, extraocular motility, and diplopia. RESULT: Both patients recovered completely without any residual eye symptoms or complications, and postoperative CT showed a completely resolved medial orbital wall. CONCLUSION: The modified technique for endoscopic endonasal reduction using a resorbable panel was effective for the reconstruction of orbital wall fractures, without complications. The modified technique may be expected to have advantages over the conventional endoscopic approach using a Silastic sheet and Merocel because it does not require long-term nasal packing, and the resorbable panel supports the orbital contents longer.

Nasal septal deviation with obstructive symptoms: Association found with asthma but not with other general health problems.

BACKGROUND: Nasal septal deviation (NSD) is a very common deformity. Because it may induce chronic upper airway obstruction in the nose, clinicians encounter some patients who have concerns about whether this can be a risk factor for general health. However, the influence of NSD on general health has rarely been studied. OBJECTIVE: To determine associations between NSD, especially NSD with nasal obstructive symptom, and general health problems in an adult Korean population. METHODS: This nationwide study analyzed data from the Korea National Health and Nutritional Examination Survey, 2008-2009. NSD was evaluated by using a nasal endoscope, and a nasal obstructive symptom was assessed via individual interviews. The survey also investigated general health problems, such as medical comorbidity, mental health status, and quality of life. Medical conditions included neurocardiovascular, respiratory, metabolic, musculoskeletal, gastrointestinal, and malignant diseases. To eliminate the effect of combined nasal problems in otorhinolaryngology, subjects with rhinosinusitis and allergic rhinitis were excluded. This study focused on obstructive NSD, which is defined as an anatomic NSD with a chronic nasal obstructive symptom. RESULTS: We enrolled 8865 participants, and the prevalence of NSD was 44.8%. No general health problems showed a significant association with NSD. However, the prevalence of NSD with an obstructive symptom was 2.1%. Obstructive NSD had no association with all the general health problems, except asthma. A significant association was found between obstructive NSD and asthma (odds ratio 2.648 [95% confidence interval, 1.211-5.791]). CONCLUSION: Among various general health problems, our study found that NSD was associated with asthma only when NSD was accompanied by a chronic nasal obstructive symptom.

Prevalence of nasal polyps and its risk factors: Korean National Health and Nutrition Examination Survey 2009-2011.

BACKGROUND: Although nasal polyps (NPs) are thought to be a common otorhinolaryngologic disease, there have been few population-based epidemiologic studies on the prevalence of NPs. The aim of this study is to evaluate the prevalence of NPs and the risk factors in the general Korean population. METHODS: The data were obtained from the Korea National Health and Nutrition Examination Survey (KNHANES) (2009-2011), which was a cross-sectional survey of noninstitutionalized populations all around the country (n = 28,009). Among them, 19,152 participants (age more than or equal to 20 years) completed medical interviews, physical examinations and endoscopic examination. Analyses were performed using a complex sample design to identify the prevalence and its risk factors. RESULTS: The weighted prevalence of NPs was 2.5%. The increased prevalence was associated with increasing age. In the multivariate analyses, male sex [adjusted odds ratio (OR) = 1.68, 95% confidence interval (CI) = 1.25-2.26], low education level (adjusted OR = 1.57, CI = 1.16-2.13), obesity (adjusted OR = 1.49, CI = 1.19-1.87), asthma (adjusted OR = 1.80, CI = 1.24-2.62), and thyroid cancer (adjusted OR = 2.98, CI = 1.26-7.09) were associated with NPs. Among those with NPs, the proportion of symptomatic NPs was 34.4% and asthma was the only significant associated risk factor. CONCLUSION: The prevalence of NPs in the Korean general population was not low despite advances in medical and surgical treatment and two thirds of the subjects with NPs were asymptomatic. Further investigation is needed to exhibit the causal relationship between the associated risk factors identified and NPs.