Alternative technique to transfer jaw relations for custom mandibular advancement devices: A case report.

Background: Oral appliance therapy for obstructive sleep apnea can be helpful in mild and moderate cases. This clinical report evaluates the efficacy of a protocol that predicts an optimal jaw position and describes the response of a young OSA patient to treatment. Clinical Presentation: A 27-year-old woman was diagnosed with moderate OSA and had an apnea-hypopnea index (AHI) of 25.8/hr. In order to fabricate a custom device, an alternative procedure to determine the optimal protrusion and vertical positioning of the jaw was applied. After a follow-up period of 14 months, her apnea-hypopnea index (AHI) significantly decreased from 25.8 to 1.0 per hr with the appliance. The total number of respiratory events decreased from 211 to 8. Conclusion: Improved polysomnographic parameters showed that the oral device was efficient in treatment. The advantages of the device in this study are that it is comfortable, economical, and simple to fabricate.

Management of obstructive sleep apnea in an edentulous lower jaw patient with a mandibular advancement device.

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder with periodic reduction or cessation of airflow during sleep. It is associated with loud snoring, disrupted sleep, and witnessed apneas. Treatment of OSA varies from simple measures such as oral appliances and nasal continuous positive airway pressure (CPAP) to surgical procedures like uvulopalatopharyngoplasty and tracheostomy. Oral appliances are a viable nonsurgical treatment alternative in patients with OSA, of which mandibular advancement devices are most common. Edentulism which contributes to the worsening of OSA reduces the number of available therapeutic strategies and is considered a contraindication to oral appliance therapy. This clinical report describes the treatment of a 63-year-old edentulous OSA patient for whom a mandibular advancement device was designed.

Pulmonary involvement in sea-blue histiocytosis.

Sea-blue histiocytosis is one of the six types of Niemann-Pick disease. It is characterized by childhood onset of hepatosplenomegaly, lack of neurological involvement and diminished sphingomyelinase activity. Pulmonary system is rarely involved sea-blue histiocytosis. In this paper, we present a 39-years-old male who had previously diagnosed as sea-blue histiocytosis at the age of 15. He was admitted to our clinic due to productive cough, hemoptysis, fever and weight loss. His symptoms did not resolve with the antibiotic treatment and further investigations revealed pulmonary involvement of sea-blue histiocytosis. After diagnostic bronchoalveolar lavage, his symptoms were improved, interestingly. This rare entity was discussed with literature survey.

[Rapid eye movement related obstructive sleep apnea syndrome: antropometric and polysomnographic findings]. / Hizli göz hareketleri ile iliskili obstrüktif uyku apne sendromu: Antropometrik ve polisomnografik bulgular.

INTRODUCTION: Obstructive sleep apnea syndrome is characterized by episodic narrowing of the upper respiratory ways accompanied by an oxygen desaturation during sleep. REM-related obstructive sleep apnea syndrome, comprises a subgroup of sleep disordered breathing with a 10-36% frequency. The aim of the present study is to analyze the frequency, the antropometric and polygraphic features of REM-related obstructive sleep apnea syndrome. MATERIALS AND METHODS: A total of 427 cases [332 males (77.4%) and 95 females (22.6%)] with definitive obstructive sleep apnea syndrome diagnosis with polysomnography records were included into the study. RESULTS: Of all the cases, 108 (25.3%) were REM-related sleep respiratory disorder. There was no difference between the two groups with regard to age and sex. However, the obstructive sleep apnea syndrome group non-related to REM demonstrated a more severe obstructive sleep apnea syndrome and a longer neck circumference. Superficial sleep was longer in the REM non-related group, while deep refreshing sleep (Non-REM 3) was longer in the REM-related group. The subgroup analysis of the REM-related group with regard to sex revealed a higher body mass index in the female subgroup. CONCLUSION: REM-related sleep respiratory disorder is more often in mild-to-moderate obstructive sleep apnea syndrome cases, the male/female ratio of REM-related sleep respiratory disorder is not different from the obstructive sleep apnea syndrome prevalence in the community.

Spindle cell sarcomatoid carcinoma: first case reported in the trachea.

A 78-years-old man presented with weight loss, dyspnea, cough and hemoptysis. He was an ex-smoker with a smoking history of 30 pack-years. Imaging studies revealed an endoluminal carinal mass and a tumoral mass arising from the posterior wall of the trachea was observed bronchoscopically. Endoscopic argon plasma coagulation was performed to take biopsies and to regain the airway passage. Recanalisation of the right and left main bronchi and the trachea was achieved together with resection of more than 90% of the tumoural mass. Microscopically, the tumor was composed of fascicular pattern of spindle cells with atypical mitotic figures and nuclear pleomorphism, positively reactive to epithelial membrane antigen supporting a diagnosis of tumour with epithelial differentiation. These findings supported the diagnosis of a spindle cell sarcomatoid carcinoma of trachea. Spindle cell carcinoma cases are reported in many sites, such as head and neck region, larynx, digestive tract, breast, kidney, genital tract, skin and lung, but to our knowledge, not in trachea. Primary malignant tracheal tumours consist mainly of squamous cell carcinoma and adenoid cystic carcinoma and generally have an aggressive course with poor prognosis. We report the first presentation of a spindle cell sarcomatoid carcinoma of trachea together with the clinical course of the patient.

Polisomnografía de parte de la noche y polisomnografía de toda la noche: comparación entre la primera y la segunda partes de la noche / Split-night versus full-night polysomnography: comparison of the first and second parts of the night

Objetivo: En el estudio de las partes inicial y final de la noche, la primera parte corresponde a la polisomnografía (PSG) estándar, que se utiliza para el establecimiento del diagnóstico del síndrome de apneas obstructivas durante el sueño, mientras que la segunda se usa para determinar el nivel adecuado de presión positiva continua de la vía aérea. El objetivo de nuestro estudio ha sido comparar los parámetros del sueño y respiratorios durante las primeras 3 h de la noche con los valores de estos mismos parámetros obtenidos a lo largo del resto del sueño y durante toda la noche. Pacientes y métodos: En el estudio participaron 45 pacientes. Todos ellos fueron evaluados mediante PSG estándar durante toda la noche. El registro y los datos de la PSG de cada paciente se dividieron en 2 períodos: PSG1, definido como las 3 h iniciales del tiempo total de sueño, y PSG2, definido como el período restante. Después se calcularon por separado los datos correspondientes al sueño y a la respiración en los períodos PSG1 y PSG2, y se compararon entre sí y con los datos obtenidos en el registro de la PSG total (PSGt). Resultados: El porcentaje del tiempo total de sueño en las fases III-IV y el índice de apneas-hipopneas fueron significativamente mayores durante el período PSG1 que durante el período PSG2 (p < 0,001), mientras que el porcentaje de tiempo del sueño con movimientos oculares rápidos (REM, de rapid eye movements) fue significativamente menor durante el primero que durante el segundo (p < 0,001). De la misma manera, el porcentaje de tiempo en las fases III-IV fue significativamente mayor y el sueño REM fue significativamente menor durante el período PSG1, en comparación con el período PSGt (p < 0,001), aunque no hubo diferencias significativas entre los períodos PSG1 y PSGt respecto al índice de apneas-hipopneas. Conclusiones: El diagnóstico durante las primeras 3 h del sueño es fiable, pues refleja lo que ocurre a lo largo de toda la noche. Además, la presión positiva respiratoria óptima determinada durante la segunda mitad de la noche también es óptima respecto a la determinada en la primera mitad

Background and objective: In a split-night study, the first part consists of standard polysomnography (PSG) for the diagnosis of obstructive sleep apnea syndrome while the second part is used to establish a suitable level of continuous positive airway pressure. The aim of our study was to compare the sleep and respiratory parameters during the first 3 hours of the night with the values found during the remainder of sleep and during the whole night. Patients and methods: Forty-five patients were included in the study. Each patient underwent a standard full-night PSG and the PSG data for each patient were divided into 2 periods: PSG1, defined as the initial 3 hours of the total sleep time and PSG2, defined as the remaining period. Sleep and breathing data from PSG1 and PSG2 were then separately computed and compared with each other and with data for the total sleep time (PSGt). Results: The percentage of total sleep time in stage III-IV and the apnea­hypopnea index (AHI) were significantly higher and the percentage of time in rapid eye movement (REM) sleep was significantly lower during PSG1 than during PSG2 (P<.001). Similarly, the percentage of time in stage III-IV sleep was significantly higher and the percentage of REM sleep was significantly lower during PSG1 than during PSGt (P<.001), but there was no significant difference in the AHI between PSG1 and PSGt. Conclusion: The diagnosis for the first 3 hours of the night will give a reliable reflection of the whole night. In addition, optimal positive airway pressure titrated during the second half of the night is also optimal for the first half of the night

[Assessment of sleep with polysomnography in patients with interstitial lung disease]. / Interstisyel akciger hastalarinda polisomnografi ile uyku özelliklerinin degerlendirilmesi.

In our study we aimed to examine the sleep structure, oxygenation and breathing pattern in interstitial lung disease (ILD) patients. We also aimed to determine whether relevance between the advanced disease and the sleep disorders exists and whether polysomnography is necessary in those patients. A total of 37 patients were examined in the study and whole night standard polysomnography was performed to all. Polysomnography results revealed that, total sleep time, time spent in NREM sleep stage III and IV, and in REM sleep were decreased. The patients had poor sleep efficiency and they spent more time as wake after sleep onset (WASO). Severe oxygen desaturations were detected during sleep and statistically significant positive correlations were found between mean awake O2 saturation and mean and lowest sleep O2 saturations. Clinical, Radiological and Physiological (CRP) scoring system was used to assess the disease stage, whether advanced or not, and statistically significant negative correlations were found between CRP score and awake and sleep O2 saturations. Obstructive sleep apnea syndrome (OSAS) was diagnosed in 24 (64.9%) patients. In those patients it was found that not the apneas but the hypopneas predominate. No difference was found among body mass indices (BMI) between the patients with and without OSAS. As a result it was concluded that a sleep study should be considered as part of the overall assessment in managing patients with ILD, and is especially indicated if there is incipient pulmonary hypertension, cor pulmonale and nocturnal arrhythmia despite normal awake blood gas tensions and symptoms as snoring and excessive day time sleepiness.