Relationship between Cephalometric and Ultrasonic Airway Parameters in Adults with High Risk of Obstructive Sleep Apnea.

Background/Objectives: Polysomnography and cephalometry have been used for studying obstructive sleep apnea (OSA) etiology. The association between craniofacial skeleton and OSA severity remains controversial. To study OSA's etiology, cephalometry, fiberoptic pharyngoscopy, polysomnography, and sleep endoscopy have been used; however, airway obstructions cannot be located. Recent research suggested ultrasonography for OSA screening and upper airway obstruction localization. Thus, this study aims to investigate the relationship between specific craniofacial cephalometric and ultrasonic airway parameters in adults at high risk of OSA. Methods: To assess craniofacial structure, lateral cephalograms were taken from thirty-three adults over 18 with a STOP-Bang questionnaire score of three or higher and a waist-to-height ratio (WHtR) of 0.5 or higher. Airway parameters were assessed through submental ultrasound. Results: NSBA correlated with tongue base airspace width, while MP-H correlated with oropharynx, tongue base, and epiglottis airspace width. SNA, SNB, and NSBA correlated with tongue width at the oropharynx. At tongue base, ANB and MP-H correlated with tongue width. SNB and NSBA were associated with deep tissue thickness at the oropharynx, while MP-H correlated with superficial tissue thickness at velum and oropharynx. Conclusions: Cephalometric parameters (SNA, SNB, ANB, NSBA, and MP-H) were correlated with ultrasonic parameters in the velum, oropharynx, tongue base, and epiglottis.

The short Thai version of functional outcomes of sleep questionnaire (FOSQ-10T): reliability and validity in patients with sleep-disordered breathing.

PURPOSE: The study is to evaluate reliability and validity of the short Thai version of Functional Outcome of Sleep Questionnaire (FOSQ-10T), in patients with sleep disordered breathing (SDB). METHODS: Inclusion criteria were Thai patients with SDB age ≥ 18 years old who had polysomnography results available. Exclusion criteria were patients unable to complete questionnaire for any reason, patients with a history of continuous antidepressant or alcohol use, and underlying disorders including unstable cardiovascular, pulmonary, or neurological conditions. All participants were asked to complete the FOSQ-10 T and Epworth sleepiness scales (ESS). Of these, 38 patients were required to retake FOSQ-10 T at 2-4 weeks later to assess test-retest reliability, and 19 OSA patients treated with CPAP were asked to do so at 4 weeks following therapy to assess questionnaire's responsiveness to treatment. RESULTS: There were 42 participants (24 men, 18 women), with a mean age of 48.3 years. The internal consistency of the FOSQ-10T was good, as indicated by Cronbach's alpha coefficient of 0.85. The test-retest reliability was good, as indicated by intraclass correlation coefficient of 0.77. The correlation between the FOSQ-10T and ESS scores (concurrent validity) was moderate (r = - 0.41). The scores of FOSQ-10T significantly increased after receiving adequate CPAP therapy, showing an excellent responsiveness to treatment. However, there was no significant association between FOSQ-10T scores and OSA severity measured by apnea-hypopnea index. CONCLUSIONS: The FOSQ-10T has good reliability and validity to use as a tool to assess QOL in Thai patients with SDB. It is convenient and potentially useful in both clinical and research settings.

Association between hypoxic burden and common cardiometabolic diseases in patients with severe obstructive sleep apnea.

PURPOSE: To determine the possible associations between total sleep time spent with arterial oxygen saturation < 90% (T90) and comorbid cardiometabolic diseases (CMDs) in patients with severe obstructive sleep apnea (OSA). METHODS: A retrospective review of the chart was conducted in patients with severe OSA diagnosed by in-lab polysomnography (PSG) between January 2018 and December 2019 at Siriraj Hospital. The patients were divided into two groups: hypoxic (T90 ≥ 10%) and nonhypoxic (T90 < 10%). The association between common CMDs including hypertension (HT), type 2 diabetes mellitus (T2DM), and impaired fasting glucose (IFG) was investigated and compared between the two groups. RESULTS: Data were collected from 450 patients with severe OSA, 289 males/161 females with a mean age of 53.5 ± 14.2 years and an apnea-hypopnea index (AHI) of 49.6 events/h. Among these, 114 patients (25.3%) were defined as the hypoxic group (T90 ≥ 10%). When compared between the hypoxic and nonhypoxic groups, the patients in the hypoxic group were significantly younger and more obese, and had a higher proportion of male patients. The majority of patients (80%) had at least one CMD; however, the most common comorbidities significantly associated with hypoxic OSA (T90 ≥ 10%) were HT and IFG. CONCLUSION: Hypoxic burden is significantly associated with an increased prevalence of HT and IFG in patients with severe OSA. T90 may be potentially useful for predicting CMDs in these patients. However, prospective studies are still required.

Association between REM-related mild obstructive sleep apnea and common cardiometabolic diseases.

PURPOSE: To explore the association between rapid eye movement-related obstructive sleep apnea (REM-OSA) and common cardiometabolic diseases (CMDs) in patients with mild OSA. METHODS: This retrospective study was conducted by reviewing the medical records and polysomnograms (PSGs) of patients at Siriraj Hospital. The PSGs of patients diagnosed with mild OSA who had ≥ 15 min of REM sleep were included. REM-OSA was defined if the apnea-hypopnea index (AHI) in REM was ≥ 2 times that of non-REM. Common CMDs included coronary artery disease, stroke, heart failure, diabetes mellitus, and hypertension. RESULTS: The data of 518 patients with a mean age of 48.3 years, 198 males, and mean AHI of 9.8 events/h were analyzed in this study. When compared with the control group, the REM-OSA group (308 patients) were predominantly female (72%), overweight (62%), and had more severe oxygen desaturation, p-value < 0.001. CMDs were significantly more common in the REM-OSA group than in the controls [odds ratio (OR) 1.52, 95% confidence interval 1.04-2.21, p-value = 0.029]. Patients with a REM AHI of ≥ 20 events/h were significantly associated with hypertension compared to those with a REM AHI of < 20 events/h, p-value = 0.001. However, these associations were found not to be statistically significant after controlling for age, sex, BMI, and prevalent coexisting CMD (OR = 1.13, 95% CI: 0.72-1.76, p-value = 0.605). CONCLUSION: Common CMDs, particularly HT, tend to show an association with REM-OSA in patients with mild OSA, but this association did not reach statistically significant levels.

Obstructive Sleep Apnea and Sensorineural Hearing Loss: A Systematic Review and Meta-analysis.

OBJECTIVES: To evaluate the associations between obstructive sleep apnea (OSA) and sensorineural hearing loss (SNHL) and the effects of continuous positive airway pressure (CPAP) therapy on SNHL. DATA SOURCES: Ovid Medline, Embase, and Scopus databases. REVIEW METHODS: A systematic search was done for studies investigating relationships between OSA and SNHL in adults, with manual searches for additional references. The final update was done on December 22, 2021. The Risk of Bias Assessment Tool for Nonrandomized Studies was applied for quality assessments. RESULTS: The 20 included studies had a total of 34,442 participants (66% male; mean age, 46.6 years). The OSA group had a significantly worse mean hearing threshold level (HTL) than the control group for midfrequency ranges (500, 1000, 2000 Hz; mean difference, 4.00 dB; 95% CI, 2.40-5.61) and high-frequency ranges (4000, 8000 Hz; mean difference, 6.24 dB; 95% CI, 2.99-9.49). An association between OSA and SNHL was found. When compared with controls, patients with OSA had an odds ratio of 1.52 (95% CI, 1.12-2.06) for midfrequency hearing impairment and 1.19 (95% CI, 1.05-1.34) for high-frequency hearing impairment. However, we did not find significant improvements in midfrequency HTL after CPAP therapy. CONCLUSIONS: HTL was significantly poorer among participants with OSA (especially in severe cases) than non-OSA controls. Studies on patients with OSA with SNHL treated with CPAP did not show significant improvements in midfrequency HTL. Further studies are warranted on these issues.

Prevalence of high-risk for obstructive sleep apnea in attention deficit hyperactivity disorder children referred to psychiatry clinic and impact on quality of life.

Objectives: To study the prevalence of high-risk obstructive sleep apnea (OSA) in attention deficit hyperactivity disorder (ADHD) children in a child and adolescent psychiatry clinic using the Thai version of the Pediatric Obstructive Sleep Apnea Screening Tool (POSAST) questionnaire. The secondary objective was to evaluate the quality of life and identify associated factors for high-risk OSA in ADHD children. Study design: Prospective cross-sectional study. Material and method: Caregivers of pediatric patients aged 5-18 years old and diagnosed with ADHD by child and adolescent psychiatrists were surveyed about their child's sleeping habits. Results: Two hundred and seventy-four subjects were included. The patients' mean age was 10.4 ± 2.6 years, and 82.8% were males. There were 30 children (10.9%) diagnosed with obesity, 46 (16.8%) with chronic rhinitis, and 9 (3.3%) with asthma. The median duration of ADHD symptoms was 22.1 months. The prevalence of high-risk OSA was 18.2% and was associated with significantly reduced quality of life (adjusted OR = 4.46, 95% CI: 2.26-8.81, P < 0.001). A significant association between high-risk OSA and obesity also emerged (adjusted OR = 2.84, 95% CI: 1.17-6.88, P = 0.021). Conclusion: An elevated prevalence of high-risk OSA is present among Thai children with ADHD, and significantly impacts quality of life. A significant association between high-risk OSA and obesity is also detected in patients with ADHD. Therefore, screening for high-risk OSA in ADHD patients may likely facilitate early detection and treatment of OSA, and potentially prevent adverse consequences.

The prevalence of high risk of obstructive sleep apnea in patients with allergic rhinitis.

BACKGROUND: Although allergic rhinitis (AR) has not been acknowledged as a strong risk factor for obstructive sleep apnea (OSA), several pathophysiological linkages between these two conditions have frequently been reported. However, epidemiological data relating to the prevalence of OSA in patients with AR remain scarce. OBJECTIVE: To investigate the prevalence of patients at high risk for OSA among patients with AR, and to determine the relationship between OSA and severity of AR. METHODS: Patients aged ≥ 18 years with a diagnosis of AR and positive skin prick test were recruited from the allergy clinic, Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand between October 2014 to November 2015. During routine follow-up, participants were asked to complete the STOP-Bang questionnaire and visual analog scale regarding AR symptoms, including their duration and severity. Patients with STOP-Bang score of ≥ 3 were considered as high risk for having OSA. RESULTS: Of the 120 AR patients (45 males, 75 females) included, there were 28 patients (19 males, 9 females) who had a STOP-Bang score of ≥ 3 (23.3%), especially for those who had longer duration of AR symptoms (low-risk/high-risk: 60/120 months, p = 0.01). However, no significant relationship was observed between ARIA classification and severity of nasal symptoms of AR for being high risk of OSA. CONCLUSIONS: The prevalence of high risk of having OSA in patients with AR was two times higher than that in general Thai population. Early screening and further management for these patients may improve treatment outcomes and quality of life.

Validity and reliability of the Thai version of the pediatric obstructive sleep apnea screening tool.

OBJECTIVE: Obstructive sleep apnea (OSA) is highly prevalent in children and requires an expensive and relatively unavailable sleep study for diagnosis. This study was undertaken to translate the previously validated pediatric OSA screening tool (POSAST) to the Thai language and assess its accuracy and test-retest reliability in at-risk symptomatic children. STUDY DESIGN: Prospective cross-sectional cohort study. METHODS: Pediatric patients clinically referred for suspected OSA who underwent overnight polysomnography (PSG) were recruited, and caregivers completed the Thai version of the POSAST. The same questionnaire was completed again after 2-4 weeks. The reliability of the questionnaire was determined by internal consistency and test-retest reliability. The validity of the questionnaire was assessed by constructing receiver operating characteristic (ROC) curves to identify the equation-derived score and total additive score cutoff points that identify high risk for moderate and severe OSA (AHI of ≥ 5 events/h). RESULTS: One hundred and ten subjects completed the study. The mean age was 8.4 ± 2.9 years. The mean apnea-hypopnea index (AHI) was 10.9 ± 11.9 events/h. Test-retest reliability (Pearson correlation coefficient = 0.96, p < .001) and internal consistency between each question (Cronbach's alpha coefficient = 0.82, p < .001) were excellent. An equation-derived score cut-off of 1.9 yielded 78.4% sensitivity, 50.0% specificity, 76.3% positive predictive value (PPV), and 52.9% negative predictive value (NPV), while a total additive score cut-off of 8 corresponded to 81.1% sensitivity, 52.8% specificity, 77.9% PPV, and 57.6% NPV for diagnosing moderate and severe OSA (AHI ≥ 5 events/h). CONCLUSION: The internal consistency and reproducibility of the Thai version of the POSAST are satisfactory, display acceptable validity, and the instrument can be used for screening symptomatic Thai children for OSA.

Randomized crossover study of tongue-retaining device and positive airway pressure for obstructive sleep apnea.

PURPOSE: To compare the efficacy of tongue-retaining device (TRD) versus continuous positive airway pressure (CPAP) for treatment of obstructive sleep apnea (OSA). STUDY DESIGN: Randomized crossover study. SUBJECTS AND METHODS: Thirty-six patients with a mean age of 52.7 ± 10.6 years were enrolled. Inclusion criteria were age ≥ 18 years, apnea-hypopnea index (AHI) ≥ 5 events/h, and minimum oxygen saturation (SO2) ≥ 70% from polysomnography (PSG). Exclusion criteria were severe periodontal disease, unstable cardiopulmonary or neurological diseases, and/or total sleep time < 2 h. A 1-week wash-in period was followed by questionnaires and randomization into two groups: TRD/CPAP and CPAP/TRD (18 patients each). After 3 weeks of intervention, questionnaires were re-administered and WatchPAT was performed. After a 1-week wash-out period, patients were switched to the other treatment. Primary outcome was AHI. Secondary outcomes were SO2, Functional Outcomes of Sleep Questionnaire (FOSQ), and Epworth Sleepiness Scale (ESS) scores, treatment side effects, and adherence. RESULTS: Nine patients withdrew, so 27 patients were included in the final analysis. Mean AHI decreased from 38.7 ± 24.0 to 2.5 ± 0.5 and 12.7 ± 2.6 events/h for CPAP and TRD, respectively (95% confidence interval of mean differences 4.65-15.62; p < 0.001). There was no significant difference in ESS and FOSQ scores between treatments. Common adverse effects were drooling, tongue numbness, and pain for TRD; and nasal blockage, mask compression, and difficult portability for CPAP. CONCLUSIONS: CPAP was superior to TRD for resolving PSG parameters; however, both similarly improved QOL and daytime sleepiness. TRD might be considered a short-term alternative treatment for OSA. TRIAL REGISTRATION: NCT02788487.

Watch Peripheral Arterial Tonometry in the Diagnosis of Pediatric Obstructive Sleep Apnea.

Objective To assess the accuracy and clinical reliability of watch peripheral arterial tonometry (PAT) compared with polysomnography (PSG) for the diagnosis of pediatric obstructive sleep apnea (OSA). Study Design Prospective, diagnostic test study. Setting National tertiary referral hospital. Subjects and Methods Patients aged 8 to 15 years with clinically suspected OSA were recruited. All participants underwent PSG and PAT simultaneously in the sleep laboratory. Results Thirty-six patients were included, with a mean age of 10.2 ± 1.8 years. Median (interquartile range) of the apnea hypopnea index (AHI) was 8.0 (5.5-12) and 2.9 (0.5-7.5) events/h, median oxygen desaturation index (ODI) was 2.5 (1.4-8.3) and 1.3 (0.2-3.8) events/h, mean ± standard deviation total sleep time was 398.4 ± 38.3 and 401.9 ± 36.1 minutes, and mean minimum oxygen saturation was 87.1% ± 8.1% and 89.4% ± 7.1% for PSG and PAT sleep parameter results, respectively. Agreement between methods was excellent for the AHI (intraclass correlation coefficient [ICC]: 0.89; 95% CI, 0.40-0.96; P < .001) and ODI (ICC: 0.87; 95% CI, 0.69-0.94; P < .001). Correlation between methods was very good for the ODI ( r = 0.83; 95% CI, 0.67-0.90; P < .001) and moderate for the AHI ( r = 0.64; 95% CI, 0.30-0.85; P < .001). From the receiver operating characteristic curve constructed to assess PAT diagnostic capability, AHI of PAT (W-AHI) at a cutoff of 3.5 events/h provided the highest accuracy (76.9% sensitivity, 78.3% specificity), while W-AHI at 10 events/h yielded 91.3% specificity for diagnosing severe OSA. Conclusion PAT correlated well and had good agreement with PSG. Children with W-AHI ≥10 had high specificity for the diagnosis of severe OSA. Larger studies with PAT designed for children across all age ranges and with a normal control group are still needed.

Adjustable thermoplastic oral appliance versus positive airway pressure for obstructive sleep apnea.

OBJECTIVES/HYPOTHESIS: To compare outcomes of continuous positive airway pressure (CPAP) and the adjustable thermoplastic mandibular advancement splint (AT-MAS) for obstructive sleep apnea treatment. STUDY DESIGN: Randomized crossover, noninferiority, tertiary center setting. METHODS: Fifty patients with a mean age of 49.5 ± 10.6 years were enrolled. Inclusion criteria were age ≥18 years, apnea-hypopnea index (AHI) ≥5 events/hour, and oxygen saturation ≥70%. Exclusion criteria were temporomandibular joint disorders, severe periodontitis, inadequate teeth, and unstable medical diseases. Treatment intolerance was considered a failure. Two-week periods without treatment were followed by questionnaires and randomization into two groups: CPAP/AT-MAS (25) and AT-MAS/CPAP (25). After 6 weeks of intervention, questionnaires and home WatchPAT monitoring were performed. Following each 2-week washout period, patients crossed over to the other treatment followed by similar procedures. Primary outcomes involved the scores from the Functional Outcomes of Sleep Questionnaire (FOSQ). Secondary outcomes were AHI, side effects, and treatment adherence. RESULTS: Seven patients withdrew from this study: five (AT-MAS intolerance) and two (lost follow-up). There was no significant difference among FOSQ scores, particularly on global scores, between both treatments (0.57, 95% confidential interval of difference: -0.15 to 1.29). Mean AHI decreased from pretreatment 39.2 ± 2.53 to 2.56 ± 0.49 and 12.92 ± 2.05 events/hour while using CPAP and the AT-MAS, respectively (P < .05). Most common side effects of CPAP were dry throat and inconvenience to carry, whereas those of the AT-MAS were jaw pain and excessive salivation. CONCLUSIONS: Both devices improved short-term quality of life similarly; however, the AT-MAS was not as efficacious as CPAP on resolving sleep-test parameters. The AT-MAS might be considered only a temporary treatment alternative. LEVEL OF EVIDENCE: 1b. Laryngoscope, 128:516-522, 2018.

Diurnal changes in retinal nerve fiber layer thickness with obstructive sleep apnea/hypopnea syndrome.

AIM: To compare the retinal nerve fiber layer (RNFL) thickness in the morning and evening in Thai patients with varying degrees of obstructive sleep apnea/hypopnea syndrome (OSAHS). METHODS: In this cross-sectional study, potential OSAHS patients at Siriraj Hospital underwent polysomnography to determine the severity of OSAHS and an eye examination (including best corrected visual acuity, slit-lamp examination, and Goldmann applanation tonometry). RNFL thickness was recorded once in the morning and once in the evening, using spectral domain optical coherence tomography. Thickness was expressed as an average and given for each quadrant. Patients with ocular or systemic diseases that might affect RNFL thickness were excluded. RESULTS: Forty-one eyes of 41 patients were classified into 4 OSAHS groups. The average and mean RNFL thickness in most of the four quadrants of the severe OSAHS group trended toward being less than those in the comparable quadrants of the other groups in both the morning and evening. In the moderate OSAHS group, the average RNFL thickness and temporal and superior quadrant thickness in the morning were significantly higher than in the evening (P=0.01, P=0.01, and P=0.03, respectively). In the severe OSAHS group, the inferior quadrant thickness in the morning was significantly higher than in the evening (P=0.03). CONCLUSION: The RNFL thickness in the morning was higher than in the evening in moderate OSAHS.

A randomized study of temperature-controlled versus bipolar radiofrequency for inferior turbinate reduction.

UNLABELLED: The objective of this study is to compare outcomes of temperature-controlled radiofrequency (TCRF) and bipolar radiofrequency (BRF) for inferior turbinate reduction in patients with chronic rhinitis (CR). This was a prospective, randomized non-inferiority trial. Eighty-four adult patients with CR refractory to medication were randomized into two intervention groups: TCRF(42) or BRF(42). Primary outcomes consisted of patient-orientated visual analog scale (VAS; 0-10) of nasal obstruction at 4th postoperative week. Secondary subjective outcomes included VAS of nasal discharge, sneezing, hyposmia, and postnasal drip. Objective outcomes included crusting, mucociliary transportation time, minimal cross-sectional area, total nasal volume, and nasal airway resistance performed by blind assessors before and at 4th postoperative week and 1-year follow-up. Baseline and perioperative data showed no statistically significant difference between both groups, except for longer operative time in TCRF (481.5 ± 36.2 vs. 37.1 ± 3.0 s, p < 0.001) and slightly more crusts in BRF group (p = 0.04). Both intention-to-treat and per-protocol analyses, TCRF(39) versus BRF(41), revealed no significant difference among subjective and objective outcomes between two groups at 4th postoperative week. The 95% confidence intervals of mean differences of VAS scores of all subjective symptoms were within defined margin (-1.5 to 1.5), except for nasal discharge. At 1-year follow-up, there was still no significant difference in the outcomes. Minimal pain and minor bleeding without serious adverse effects from both interventions were reported. Both BRF and TCRF resulted in similar short-term outcomes, while less operative time was found in BRF group. Further studies, particularly, on cost-effectiveness should be conducted for better treatment selection. LEVEL OF EVIDENCE: 1b.

Diagnostic properties of the STOP-Bang and its modified version in screening for obstructive sleep apnea in Thai patients.

OBJECTIVE: To test the diagnostic properties of the original and a modified STOP-Bang, as well as testing the additional use of a waist-to-height ratio (WHtR) of > or = 0.55 in screening for obstructive sleep apnea (OSA) in Thai patients. MATERIAL AND METHOD: Three hundred and three patients (186 males and 117 females) who underwent anthropometric measurement and standard polysomnography were asked to complete the STOP-Bang questionnaire. Subjects were considered high-risk if their scores were > or = 3. Patients with significant co-morbidities were excluded. RESULTS: Screening for OSA involved measurements of STOP-Bang sensitivity, specificity, positive predictive value, and negative predictive value at several apnea-hypopnea index (AHI) cut-off points. At AHI 5, these values were 87.3%, 48.1%, 82.2%, and 52.2%, respectively. At AHI 15, these values were 92.6%, 36.4%, 58.5%, and 83.6%, respectively. The modified STOP-Bang (using a cut-off of BMI > 30 kg/m2) showed slightly increased sensitivities at the AHI cut-off points of 5 and 15 with values of 88.7% and 93.2%, respectively, with improved area under the curves. Furthermore, by applying the WHtR of > or = 0.55 to those patients who were classified as high-risk by the questionnaires, the specificities for predicting OSA were improved to 85.2% and 76.1% for the aforementioned cut-off points, respectively. CONCLUSION: Both STOP-Bang and its modified version were highly sensitive measures for OSA screening in medical or dental clinics. However, the modified version might be more suitable for Thais and Asians, and the additional use of WHtR > or = 0.55 might be useful for reducing the unnecessary sleep investigation or management in those who were classified as high-risk patients.

Reliability and validity of a Thai version of the Berlin questionnaire in patients with sleep disordered breathing.

OBJECTIVE: To assess the validity and test-retest reliability of a Thai version of the Berlin Questionnaire in patients with sleep disorder breathing. MARTIAL AND METHOD: Patients who were suspected of sleep disordered breathing attending the outpatient department of Siriraj Hospital and who had undergone polysomnography were recruited and asked to complete a Thai version of the Berlin questionnaire. Each participant was asked to repeat the same questionnaire over the next 2-4 weeks for test-retest reliability. RESULTS: One hundred and thirty-two patients completed the present study. The age range of the patients was 26-72 years (mean, 48.15 ++/- .80 years). All 10 items of the Thai version of the Berlin questionnaire were moderately correlated in internal consistency (Cronbach's alpha correlation coefficient = 0.68). The test-retest reliability of the Thai version of the Berlin questionnaire was investigated in 98 patients and demonstrated a high degree of reliability in intra class correlation (ICC = 0.97). CONCLUSION: The present study reveals, for the first time, that the Thai version of the Berlin questionnaire has satisfactory validity and reliability when compared to the original English version.

Radiofrequency inferior turbinate reduction improves smell ability of patients with chronic rhinitis and inferior turbinate hypertrophy.

Radiofrequency inferior turbinate reduction (RFITR) of inferior turbinate hypertrophy (ITH) is an effective way to treat patients with intractable nasal mucosal obstruction. The objective of this study was to assess smell ability, nasal symptoms, inferior turbinate grading (ITG), peak nasal inspiratory flow (PNIF) of patients with chronic rhinitis (CR), and ITH before and after RFITR. Patients with CR and ITH, aged 18-60 years, who underwent RFITR, were prospectively recruited. Smell ability (measured by smell detection threshold [SDT]), visual analog scale (VAS) of nasal symptoms, ITG, and PNIF before and 6-10 weeks after RFITR were compared. Forty-eight subjects were included. All nasal symptoms were significantly decreased after RFITR. After surgery, SDT (tested by phenyl ethyl alcohol) was worsened in 7 patients (14.6%), improved in 8 patients (16.7%), and did not change in 33 patients (68.7%). SDT after RFITR of six patients in the worsened SDT group were still within normal range (> -6.5). There was only one patient whose SDT changed from normosmia to mild hyposmia (-7.25 to -5.38). In the improved SDT group, two of eight patients had obviously better SDT after RFITR, which changed from moderate hyposmia to normosmia (-3.65 to -10; -3.73 to -10), whereas six of eight patients had little better SDT after RFITR. RFITR also significantly reduced ITG and improved PNIF. In conclusion, the treatment of patients with CR and ITH with RFITR significantly improved PNIF, ITG, and nasal symptoms assessed by VAS, although SDT after RFITR could be the same or improved or worsened.

Home-based diagnosis of obstructive sleep apnea by polysomnography type 2: accuracy, reliability, and feasibility.

PURPOSE: Despite being used in large cohort studies, role of polysomnography (PSG) type 2 is still controversy. This study was aimed to determine its accuracy, reliability, and feasibility in diagnosis of obstructive sleep apnea (OSA) compared to gold standard. METHODS: Adult patients with stable medical conditions who complained of snoring or excessive sleepiness and lived around Bangkok were recruited from a sleep clinic. All were asked to fill questionnaires and have PSG done in laboratory (in-Lab PSG) and at home (Home PSG) on separate nights within 2-4 weeks interval. RESULTS: Eighty-six patients, 48 males and 38 females, were included. Mean of total sleep time, sleep efficiency, and stage R were significantly greater in Home PSG than in-Lab PSG (p<0.05). Apnea-hypopnea index (AHI) was slightly higher in Home PSG (25.7 versus 23.5, p=0.04), but with excellent reliability, intra-class correlation coefficients of 0.96 (95% CI; 0.93-0.97), and good agreements (κ=0.59-0.70) between both tests. The sensitivity, specificity, and accuracy of Home PSG at cut-off point of AHI≥5, were 0.97, 0.56, and 0.85, respectively, and at AHI≥15 were 0.95, 0.76, and 0.85, respectively. Sixty-four patients (74.4%) preferred home-PSG but four patients (4.7%) needed repeated tests due to significant data loss. CONCLUSIONS: This is the first report in Asia demonstrating that home-based diagnosis of OSA by PSG type 2 was feasible performing with good reliability, high accuracy, and a low failure rate. However, further studies focusing on its cost-effectiveness are required.

Adjustable thermoplastic mandibular advancement device for obstructive sleep apnea: outcomes and practicability.

OBJECTIVES/HYPOTHESIS: To assess outcomes including efficacy, adverse effects, and quality of life (QOL) of an adjustable thermoplastic mandibular advancement device (AT-MAD) fitted by an otolaryngologist for obstructive sleep apnea (OSA) treatment. STUDY DESIGN: Prospective, nonrandomized, before-after study. METHODS: Sixty-four adult patients (40 men and 24 women) were recruited. Inclusion criteria were OSA patients who had failed or refused treatment with continuous positive airway pressure and surgery. Exclusion criteria were insufficient teeth, active intraoral disease, and temporomandibular joint (TMJ) disorders. Outcomes were measured using polysomnography, symptom questionnaires, Epworth Sleepiness Scale (ESS), and Functional Outcomes of Sleep Questionnaire (FOSQ) before treatment and 4 to 6 months thereafter. RESULTS: Mean apnea-hypopnea index (AHI) and ESS scores decreased from 17.7 ± 14.6 to 7.5 ± 10.9 and from 8.7 ± 4.9 to 6.5 ± 4.4, respectively, after treatment (P < .001). Thirty-nine patients (60.9%) achieved post-treatment AHI of <5, with the highest success rate in those with mild OSA (75%). FOSQ global scores increased from 16.4 ± 2.8 to 17.7 ± 3.0 (P < .05), along with most FOSQ subscale scores. Thirty-four patients (53.1%) regularly used the device for ≥5 nights per week. Adverse effects include TMJ discomfort, dry mouth, and excessive salivation, which were largely tolerable. Only four patients withdrew from the study because of adverse effects. CONCLUSIONS: This is the first study in Asians demonstrating that an AT-MAD, if done properly, is a practical short-term treatment of OSA, with good outcomes including improved QOL. Its advantages are its low cost and ready-to-use nature. However, further randomized controlled trials are required.

Combined radiofrequency volumetric tissue reduction and lateral outfracture of hypertrophic inferior turbinate in the treatment of chronic rhinitis: short-term and long-term outcome.

BACKGROUND: Radiofrequency volumetric tissue reduction (RFVTR) of hypertrophic inferior turbinate (IT) is an effective way to treat patients with intractable nasal mucosal obstruction. We evaluated the effectiveness of combined RFVTR and lateral outfracture (LO) of hypertrophic IT in chronic rhinitis (CR) patients on reduction of nasal obstruction, rhinorrhea, and nasal pruritus both short and long term. METHODS: Seventy-three patients with CR who failed medical treatment were recruited to undergo combined RFVTR and LO of hypertrophic IT. Nasal congestion scores were recorded before the operation, and immediately, 2 weeks, 6 weeks, 3 months, 6 months, 1 year, 2 years, and 3 years after the operation. Rhinorrhea and pruritic score as well as total nasal airway resistance (TNAR) and total nasal airflow (TNAF) (measured by active anterior rhinomanometry) were recorded before the operation, and 2 weeks, 6 weeks, 3 months, 6 months, 1 year, 2 years, and 3 years after the operation. RESULTS: Forty-five patients completed the follow-up period of 3 years. Subjects consisted of 25 male and 20 female patients, with an average age of 31 years. Nasal congestion scores were significantly improved immediately after the operation. Nasal congestion scores and TNAR values were significantly decreased whereas TNAF values were significantly increased at every time point postoperatively. Rhinorrhea and pruritic scores were also significantly improved at every time point after 2 weeks postoperatively. CONCLUSION: Combined RFVTR and LO of hypertrophic IT is an effective treatment for nasal obstruction, rhinorrhea, and nasal pruritus in CR and the result lasts up to 3 years postoperatively.

Physical predictors for moderate to severe obstructive sleep apnea in snoring patients.

PURPOSE: This study aimed to identify physical findings that may predict the presence of moderate to severe obstructive sleep apnea (OSA) in snoring patients. METHODS: A total of 283 subjects (165 males and 118 females) were recruited, including 217 OSA patients and 66 patients with apnea-hypopnea index (AHI)<5 as a control group, diagnosed by level-1 polysomnography. Baseline data of patients including age, sex, weight, height, body mass index (BMI), neck circumference (NC), waist circumference (WC), neck-to-height ratio (NHtR), and waist-to-height ratio (WHtR) were recorded. Other physical parameters such as chin length (Chin1), thyromental distance, hyomental distance, cricomental distance, cricomental space (CMS), Friedman tongue position (FTP), and tonsils size were recorded by a single investigator who was blinded to the PSG results. RESULTS: The findings that were statistically different between the control group and moderate to severe OSA (AHI ≥ 15) included sex, BMI, NC, NHtR, WC, WHtR, Chin1, CM, and CMS (p<0.05). However, logistic regression analysis showed that only male gender and WHtR ≥ 0.55 were the independent predictors for AHI ≥ 15 with adjusted odds ratios of 6.6 and 3.1, respectively. CONCLUSION: Among snoring patients seeking medical consultation, male gender and WHtR of ≥ 0.55 were good predictors for moderate to severe OSA. No single head and neck finding reliably predicted this condition. In a situation with limited facilities, these data along with medical history may be helpful for prioritizing patients in order to achieve the optimal use of sleep investigation and treatment.