Hypoglossal nerve stimulation in three adults with down syndrome and severe obstructive sleep apnea.

We present three adults with Down syndrome and obstructive sleep apnea (OSA) treated with hypoglossal nerve stimulation. The average age of these three males was 37.3 years. All patients had severe OSA on polysomnography. Postimplantation titration sleep studies exhibited residual OSA according to average total apnea-hypopnea index (AHI), but there were significant reductions (86%-100%) in the titrated AHI at the ideal device setting. Morbidity of the surgery was low, and there was excellent device adherence, with an average of 57.3 hours/week. All patients reported subjective improvements in symptoms, and one patient experienced improved blood sugar control. Laryngoscope, 129:E402-E406, 2019.

Tongue-lip adhesion and tongue repositioning for obstructive sleep apnoea in Pierre Robin sequence: A systematic review and meta-analysis.

OBJECTIVE: To search for studies on tongue-lip adhesion and tongue repositioning used as isolated treatments for obstructive sleep apnoea in children with Pierre Robin sequence. METHODS: A systematic literature search of PubMed/Medline and three additional databases, from inception through to 8 July 2016, was performed by two authors. RESULTS: Seven studies with 90 patients (59 tongue-lip adhesion and 31 tongue repositioning patients) met the inclusion criteria. Tongue-lip adhesion reduced the mean (± standard deviation) apnoea/hypopnoea index from 30.8 ± 22.3 to 15.4 ± 18.9 events per hour (50 per cent reduction). The apnoea/hypopnoea index mean difference for tongue-lip adhesion was -15.28 events per hour (95 per cent confidence interval = -30.70 to 0.15; p = 0.05). Tongue-lip adhesion improved the lowest oxygen saturation from 75.8 ± 6.8 to 84.4 ± 7.3 per cent. Tongue repositioning reduced the apnoea/hypopnoea index from 46.5 to 17.4 events per hour (62.6 per cent reduction). Tongue repositioning improved the mean oxygen saturation from 90.8 ± 1.2 to 95.0 ± 0.5 per cent. CONCLUSION: Tongue-lip adhesion and tongue repositioning can improve apnoea/hypopnoea index and oxygenation parameters in children with Pierre Robin sequence and obstructive sleep apnoea.

Using low level laser therapy to reduce early postoperative airway obstruction following modified Hogan’s flap / El uso de la terapia con láser de baja intensidad para reducir la obstrucción de la vía aérea postoperatoria temprana después del colgajo de Hogan modificado

Introduction and objective: The most common postoperative complications of velopharyngeal insufficiency surgery are postoperative bleeding and airway obstruction or obstructive sleep apnoea. Consequently, the aim of this study was to evaluate the effect of low level laser therapy (LLLT) during the first postoperative days in children undergoing superiorly based pharyngeal flap (SBF) surgery. Materials and methods: A randomized double blind clinical study on 30 children divided on two groups 15 patients each, who underwent SBF. LLLT was used in a group and the other was a control group. The study was conducted in academic tertiary care medical centres between 2013 and 2015. The degree of edema, oxygen saturation, occurrence of obstructive sleep apnoea (OSA) and steroid administration were recorded. Results: The mean of the average oxygen saturation was significantly less in the control group in the 1st and 2nd day as compared to the laser group. The need for oxygen and the incidence of OSA in the first 3 days were significantly higher in the control group as compared to the laser group. The degree of edema showed no significant difference in the first day but was significantly higher in the control group in the 2nd and 3rd days. Hence, the need of steroids was significantly higher in the control group in the first 3 days. Conclusions: Preliminary results showed that low level laser therapy is effective in reducing the incidence of early postoperative airway obstruction after SBF operations (AU)

Introducción y objetivo: La más común de las complicaciones postoperatorias tras la cirugía de la insuficiencia velofaríngea son el sangrado y la obstrucción postoperatoria de las vías respiratorias, o la apnea obstructiva del sueño. Por lo tanto, el objetivo de este estudio fue evaluar el efecto de la terapia láser de baja intensidad durante los primeros días del postoperatorio en niños sometidos a colgajo faríngeo de base superior (SBF). Métodos: Estudio clínico aleatorizado doble ciego en 30 niños, entre el grupo de láser y el grupo control, que fueron sometidos a SBF. El estudio se llevó a cabo en dos centros médicos académicos de atención terciaria, entre 2013 y 2015. Se registró grado de edema, la saturación de oxígeno, la aparición de apnea obstructiva del sueño y la necesidad de esteroides. Resultados: Durante los 3 primeros días, la media de la saturación de oxígeno muestra cambios significativos entre los dos grupos. Por otra parte, la necesidad de oxígeno en los primeros 3 días muestra también cambios significativos entre los dos grupos. Así como la incidencia de apnea obstructiva del sueño. El grado de edema no muestra ningún cambio significativo en el primer día, pero sí en los 2 días siguientes. Por lo tanto, la necesidad de esteroides en los primeros 3 días también muestra cambios significativos entre los dos grupos. Conclusiones: Los resultados preliminares mostraron que la terapia con láser de baja intensidad es eficaz en la reducción de la incidencia de obstrucción de vía aérea en el postoperatorio temprano después de las operaciones SBF (AU)

Atorvastatin attenuates myocardial remodeling induced by chronic intermittent hypoxia in rats: partly involvement of TLR-4/MYD88 pathway.

Inflammatory processes and oxidative stress are known to play a key role in the development of cardiovascular complications such as cardiac hypertrophy induced by chronic intermittent hypoxia (CIH), the most characteristic pathophysiological change of obstructive sleep apnea syndrome (OSAS). Current evidence suggests that competitive inhibitors of 3-hydroxy-3-methylglutaryl-CoA coenzyme A reductase, such as atorvastatin, not only reduce blood lipids but also have anti-inflammatory and inhibit oxidative stress benefits. This study examined the protective role of atorvastatin in CIH-induced cardiac hypertrophy. Adult male wistar rats were subjected to 8h of intermittent hypoxia/day, with/without atorvastatin for 6 weeks. Ventricular remodeling, toll-like receptor 4 (TLR-4), myeloid differentiation primary response protein 88 (MYD88), inflammatory agents and radical oxygen species were determined. As a result, we found that treatment with atorvastatin markedly inhibited the mRNA and protein expressions of TLR4, MYD88 and the downstream inflammatory agents and radical oxygen species. Administration of atorvastatin following CIH significantly ameliorated the myocardial injury, such as cardiac hypertrophy. In conclusion, Pre-CIH atorvastatin administration may attenuate TLR-4/MYD88 mediated inflammatory processes and oxidative stress in the injured rat myocardium, and this may be one mechanism by which atorvastatin ameliorated myocardial injury following CIH.

[The Tübingen palatal plate--an innovative therapeutic concept in Pierre-Robin sequence]. / Die Tübinger Gaumenplatte--Ein innovatives Therapiekonzept bei Pierre-Robin-Sequenz.

Infants with Pierre-Robin sequence (PRS) may suffer severe upper airway obstruction resulting in hypoxemia that is difficult to treat. We are currently evaluating a new therapeutic approach involving an oral appliance that widens the pharynx by pulling the base of the tongue forward using a preepiglottic baton. Here we present a patient treated with this device who showed a decrease in his desaturation index from 50 to < 1.