Sleep medicine in otolaryngology units: an international survey.

PURPOSE: No study to date has described the overall landscape of sleep disorders management and training in otolaryngology departments of different countries. The aim of our study was to investigate and compare settings, diagnostic and therapeutic approaches and training programmes. METHODS: An international online survey was developed with the collaboration of the YO-IFOS (Young Otolaryngologists-International Federation of Otorhinolaryngological Societies) to assess the current practice of otolaryngologists in the management of sleep disorders. The survey also included a session dedicated to training. RESULTS: A total of 126 otolaryngologists completed the survey. The larger part of responses was collected from Central/South America and Europe. The majority of responders from South/Central America (97%) declared to be certified as sleep specialist while 49% of Europeans stated the opposite. Of responders 83% perform a drug-induced sleep endoscopy (DISE) before planning a possible surgical intervention. Soft palate and base of tongue interventions were the most common procedure, respectively performed in 94% and 79% of the cases. Residents were allowed to perform soft palate surgery in 77% of the cases. Upper airway stimulation (26% vs 10%), trans-oral robotic surgery (36% vs 11%) and radiofrequency of the base of the tongue (58% vs 25%) were preferred more frequently by European responders. The highest caseloads of soft palate surgery and bi-maxillary advancement were registered in the academic institutions. CONCLUSION: Significant concordance and few interesting divergences in diagnosis and treatment of sleep disorders were observed between nationalities and types of institution. Economic resources might have played a significant role in the therapeutic choice. Trainees' lack of exposure to certain interventions and to a sufficient caseload appeared to be the main burden to overcome.

Effects of surgically assisted rapid maxillary expansion on the modification of the pharynx and hard palate and on obstructive sleep apnea, and their correlations.

PURPOSE: To investigate the changes induced by surgically assisted rapid maxillary expansion (SARME) on palate and pharynx morphology as well as the correlation of these changes with the improvement of obstructive sleep apnea (OSA). MATERIALS AND METHODS: The study was conducted in 16 patients, seven women and nine men, aged on average 40.23 ± 10.23 years, all of them with OSA confirmed by polysomnography (PSG) and with posterior crossbite. All participants underwent computed tomography (CT) and PSG before and after SARME. The CT scans were used to determine the dimensions of the palate and pharynx before and after surgery. Data were analyzed statistically by the paired t-test, Wilcoxon test and Pearson correlation, with the level of significance set at P < 0.05. RESULTS: A 56.24% reduction in apnea and hypopnea index was detected (from 33.23 ± 39.54 to 14.54 ± 19.48: P = 0.001). The total airway area increased on average by 23.99% (P = 0.016), although in a more expressive manner in its lower half (28.63%, P = 0.008). A 24% transverse bone increase was observed in the palate in the region of the first premolars and an 18% increase in the region of the first molars (from 2.42 ± 0.31 to 2.99 ± 0.26. P < 0.001, and from 3.11 ± 0.32 to 3.70 ± 0.41, P < 0.001, respectively), and a mean 15% reduction of its depth (from 1.07 ± 0.33 to 0.89 ± 0.18, P = 0.014). A moderate correlation was detected between palate depth and width and OSA severity, as well as a correlation of the reduction of palate depth and its transverse increase with the improvement of OSA, especially among patients with severe OSA. CONCLUSION: It appears that narrowing of the palate, especially in the premolar region, and its greater depth may be related to the severity of OSA. SARME promotes transverse maxillary widening and lowering of palate depth, thus reducing OSA among adults and expanding the airway, especially in its lower half.

Uvulopalatoplastia a laser. Análise comparativa da melhora clínica e dos critérios de indicaçäo / Laser-assisted uvulopalatoplasty. Comparative analisys of the clinical improvement and the indication criteria

Introduçäo: O ronco e a apnéia do sono leve podem ser tratados cirurgicamente com a LAUP, sendo que os resultados dependem diretamente dos critérios adotados para seleçäo dos pacientes. O objetivo dos autores é analisar comparativamente os critérios adotados para seleçäo dos pacientes e a respectiva melhora no pós-operatório. Forma de estudo: Clínico prospectivo randomizado. Material e método: Foram selecionados 44 pacientes com ronco primário e apnéia leve, sendo avaliados clinicamente e pelas escalas de Epworth e Stanford (ronco e sonolência diurna) no pré- e pós-operatórios. Resultados: No seguimento pós-operatório de um mês, houve em média melhora clínica de 76 por cento dos roncos, sendo que na escala de Epworth houve reduçäo de 70 por cento, na de ronco de 75 por cento e na de sonolência diurna de 75 por cento. Com base na escala de Epworth (acima de 12) foi realizada polissonografia em 12 pacientes (27 por cento), dos quais nove (75 por cento) apresentarem apnéia leve. Conclusäo: A obtençäo de resultados satisfatórios depende da exclusäo dos pacientes com apnéia moderada, grave e central, que foi estimada com os critérios adotados e confirmada pela polissonografia. A melhora clínica foi acompanhada pela reduçäo nos valores obtidos nas escalas de Epworth e Stanford