Voice Change After Adenotonsillectomy in Children: A Systematic Review and Meta-Analysis.

OBJECTIVE: Adenotonsillectomy is one of the most common surgical procedures performed on children. Caregivers are often concerned about voice change after the procedure, and such concerns remain unsettled. This meta-analysis analyzed voice change in children after adenotonsillectomy. DATA SOURCES: The PubMed, Medline, EMBASE, and Cochrane databases. REVIEW METHODS: The study protocol was registered on PROSPERO. Two authors independently searched for articles using keywords "adenoidectomy," "tonsillectomy, "voice," "nasalance,"and "speech." English articles specifying voice changes after adenotonsillectomy were pooled with standardized mean difference (SMD) using random-effects model. Evaluation methods were computerized acoustic voice analysis, aerodynamic analysis, nasometer, rhinomanometry, evaluations from a speech-language pathologist or otolaryngologist, and a caregiver assessment questionnaire. RESULTS: Twenty-three studies with 2154 children were analyzed (mean age: 8.0 y; 58% boys; mean sample size: 94 children). Due to insufficient data for other outcome variables, this meta-analysis only summarized changes in the computerized acoustic voice analysis 1 month and 3 months after surgery. The computerized acoustic analysis revealed significant changes in jitter (SMD = -0.36; 95% confidence interval [CI]: -0.60 to -0.11), shimmer (SMD = -0.34; 95% CI: -0.57 to -0.11), and soft phonation index (SMD = -0.36; 95% CI: -0.57 to -0.15) at 1 month after surgery. Parameters including fundamental frequency, jitter, noise-to-harmonics ratio, and shimmer were not significantly changed at 3 months after surgery. CONCLUSIONS: This meta-analysis observed small improvements in jitter, shimmer, and soft phonation index 1 month after surgery. No significant effects were observed in voice outcomes 3 months after surgery. Laryngoscope, 2023.

Effects of RF Magnetron Sputtering Power on the Mechanical Behavior of Zr-Cu-Based Metallic Glass Thin Films.

Zirconium-based metallic glass films are promising materials for nanoelectronic and biomedical applications, but their mechanical behavior under different conditions is not well understood. This study investigates the effects of radio frequency (RF) power and test temperature on the nanostructure, morphology, and creep behavior of Zr55Cu30Al10Ni5 metallic glass films prepared by RF magnetron sputtering. The films were characterized by X-ray diffraction and microscopy, and their mechanical properties were measured by a bulge test system. The results show that the films were amorphous and exhibited a transition from noncolumnar to columnar morphology as the RF power increased from 75 W to 125 W. The columnar morphology reduced the creep resistance, Young's modulus, residual stress, and hardness of the films. The creep behavior of the films was also influenced by the test temperature, with higher temperature leading to higher creep strain and lower creep stress. The findings of this study provide insights into the optimization of the sputtering parameters and the design of zirconium-based metallic glass films for various applications.

In search of a better CPAP interface: A network meta-analysis comparing nasal masks, nasal pillows and oronasal masks.

Until now, no study has directly network meta-analysed the impact of nasal masks, nasal pillows and oronasal masks on continuous positive airway pressure therapy in patients with obstructive sleep apnea. This study aimed to meta-analyse the impact of three kinds of nasal interfaces with both network meta-analysis and pairwise comparison. PubMed, EMBASE, CENTRAL and ClinicalTrials.gov were systematically searched from inception to December 2020 for studies that compared the three types of nasal interfaces for treating obstructive sleep apnea with continuous positive airway pressure. The outcomes were residual apnea-hypopnea index, continuous positive airway pressure, and nightly average usage. The network meta-analysis was conducted using multivariate random-effects in a frequentist framework where three interfaces were ranked with the surface under the cumulative ranking probabilities. The pairwise comparison was conducted using random-effects meta-analysis. Twenty-nine articles comprising 6378 participants were included. The pairwise comparison showed both nasal masks and nasal pillows were associated with lower residual apnea-hypopnea index, lower continuous positive airway pressure, and higher continuous positive airway pressure adherence compared with oronasal masks. The surface under the cumulative ranking confirmed that nasal masks were associated with the lowest residual apnea-hypopnea index and highest adherence, while pillows were associated with the lowest continuous positive airway pressure. The meta-regression identified that lower pretreatment apnea-hypopnea index and continuous positive airway pressure determined during continuous positive airway pressure titration (versus determined during continuous positive airway pressure therapy) was associated with lower continuous positive airway pressure with nasal masks and nasal pillows. In conclusion, compared with oronasal masks, nasal masks and nasal pillows are better interfaces, especially in patients with lower pretreatment apnea-hypopnea index and those with the therapeutic pressure determined during continuous positive airway pressure titration.

Effect of Sleep Surgery on Inflammatory Cytokines in Adult Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis.

OBJECTIVE: To evaluate whether sleep surgery is associated with inflammatory cytokine changes. This study hypothesizes cytokines may change after surgery in adult obstructive sleep apnea (OSA). STUDY DESIGN: Systematic review and meta-analysis. METHODS: The study protocol was registered on PROSPERO (CRD42020154425). Two authors independently searched PubMed, Embase, and Cochrane review databases from their inception to June 2021. The keywords used were sleep apnea, inflammatory markers, cytokines, and surgery. The effects of sleep surgery on the apnea-hypopnea index (AHI) and inflammatory cytokines were evaluated using a random-effects model. Both mean difference (MD) and standardized mean difference (SMD) of the changes in cytokines were calculated. RESULTS: Nine studies with 235 adults were included (mean age: 43 years; 82% were men). After sleep surgery, AHI significantly reduced by -11.3 events/h (95% confidence interval [CI], -15.8 to -6.9). In total, 8 and 6 studies were pooled for examining tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) levels, respectively. Sleep surgery significantly reduced TNF-α levels, with an MD of -2.8 pg/ml (95% CI, -5.1 to -0.6) and an SMD of -0.56 (95% CI, -0.85 to -0.27). Furthermore, sleep surgery reduced IL-6 levels, with an MD of -0.6 pg/ml (95% CI, -1.0 to -0.2) and an SMD of -0.66 (95% CI, -0.89 to -0.43). No covariates were identified to be correlated with cytokine changes in subgroup and meta-regression analyses. Funnel plots showed possible publication bias in current data. CONCLUSIONS: In adults, OSA treatment with sleep surgery improves inflammatory cytokines. Laryngoscope, 132:2275-2284, 2022.

Effect of sleep surgery on lipid profiles in adults with obstructive sleep apnea: a meta-analysis.

PURPOSE: The effects of sleep surgery on the lipid profile of adults diagnosed as having obstructive sleep apnea (OSA) remain unclear. This meta-analysis aimed to clarify whether sleep surgeries improve patients' lipid profile. METHODS: The study protocol was registered on PROSPERO (CRD42020154425). Two authors independently searched the PubMed, MEDLINE, EMBASE, and Cochrane review databases up to September 2020 using keywords such as sleep apnea, OSA, sleep apnea syndromes, lipids, and surgery. The effects of sleep surgery on the apnea-hypopnea index (AHI) and lipid profile parameters were evaluated using a random-effects model. RESULTS: Thirteen studies were included, with a total of 710 patients (mean age: 42.0 years; 85% men; mean sample size: 54.6 patients). The summary estimate of AHI change was - 20.6 events/h (95% CI - 25.9 to - 15.3) and the Epworth Sleepiness Scale score was - 4.2 (95% CI - 5.9 to - 2.5). Sleep surgery lowered total cholesterol (mean - 7.7 mg/dL; 95% CI - 12.2 to - 3.2), low-density lipoprotein (mean - 7.2 mg/dL; 95% CI - 11.0 to - 3.3), and triglyceride (mean - 14.0 mg/dL; 95% CI - 22.2 to - 5.8) levels but did not affect high-density lipoprotein (mean 1.5 mg/dL; 95% CI - 0.6 to 3.7) levels. Subgroup analysis revealed that the lipid profile changes were not associated with the surgical procedure but with the degree of OSA improvement. Meta-regression analyses demonstrated that the improvement in the lipid profile was positively correlated with AHI reduction. CONCLUSION: Surgeries for OSA may improve the lipid profile, which is positively correlated with the degree of OSA improvement.

Prevalence of sleep disorders in children with chronic kidney disease: a meta-analysis.

BACKGROUND: The reported prevalence of sleep disorders in children with chronic kidney disease (CKD) varies greatly. A quantitative meta-analysis to estimate the prevalence of sleep disorders among pediatric CKD patients may provide further information. OBJECTIVES: The objective of this study is to estimate the prevalence of sleep disorders in children with CKD. The study protocol was registered on PROSPERO (registration number CRD42021268378). DATA SOURCES: Two authors independently searched the PubMed, MEDLINE, EMBASE, and Cochrane review databases up to June 2021. STUDY ELIGIBILITY CRITERIA: Eligible studies include data of prevalence of sleep disorders in children with CKD. STUDY APPRAISAL AND SYNTHESIS METHODS: The prevalence of restless legs syndrome, sleep-disordered breathing, pediatric obstructive sleep apnea (i.e., apnea-hypopnea index > 1 event/h in polysomnography), excessive daytime sleepiness, and insomnia/insufficient sleep was estimated using a random-effects model. Subgroup analyses were conducted to compare the prevalence of sleep disorders between children on dialysis and not on dialysis. This meta-analysis included 12 studies with 595 children (mean age: 12.9 years; gender ratio: 55.6% boys; mean sample size: 49.6 patients). RESULTS: The prevalence of restless legs syndrome in children with CKD was 21% (95% confidence interval [CI], 14-30%). The prevalence of sleep-disordered breathing, pediatric obstructive sleep apnea, excessive daytime sleepiness, and insomnia/insufficient sleep was 22% (95% CI, 12-36%), 34% (95% CI, 19-53%), 27% (95% CI, 17-41%), and 14% (95% CI, 7-27%), respectively. Subgroup analysis revealed the pooled prevalence of excessive daytime sleepiness was significantly higher in children on dialysis than in children not on dialysis (43.3% vs. 11.2%; P = 0.018). Children on dialysis also had a high prevalence of other sleeping disorders, although the differences did not reach statistical significance. Children with CKD exhibited a 3.9-fold (95% CI, 1.37 to 10.93) increased risk of restless legs syndrome and a 9.6-fold (95% CI, 3.57 to 25.76) increased risk of excessive daytime sleepiness compared with controls. LIMITATIONS: The selected papers are of small sample size, lack of a control group, and exhibit substantial heterogeneity. CONCLUSIONS: Sleep disorders are common in children with CKD. Our results indicate that while the prevalence rates of various sleep disorders were higher in children on dialysis than in children not on dialysis, the prevalence of excessive daytime sleepiness was statistically significant in children on dialysis. A higher resolution version of the Graphical abstract is available as Supplementary information.

The Effects of Stresses and Interfaces on Texture Transformation in Silver Thin Films.

Thin metal films are critical elements in nano- and micro-fabricated technologies. The texture orientation of thin films has a significant effect on applied devices. For Face-Centered Cubic (FCC) metal thin films, when the critical thickness is reached, the texture orientation can transform from (111) to (100) based on the model related to the balance between interfacial energy and strain energy. This research focused on the texture transformation of thin films under two conditions: (1) with or without an adhesion layer in the thin film and (2) with or without initial stress applied through a four-point bending load. In the experiment, two samples (silicon/silver and silicon/titanium/silver) were used to apply different initial stress/strain values and different annealing times. After annealing, an X-ray Diffractometer (XRD) was used to ascertain the preferred orientation of the thin films and the percentage of (111) and (100). Finally, Electron Back-Scattered Diffraction (EBSD) was used to observe the grain size of the thin films. The results showed that, regardless of the existence of an adhesion layer, texture transformation occurred, and this was relatively significant with Ti adhesion layers. Further, the initial stress was found to be small compared to the internal stress; thus, the initial stress imposed in the tests in this research was not significantly influenced by the texture transformation.

Effect of sleep surgery on blood pressure in adults with obstructive sleep apnea: A Systematic Review and meta-analysis.

This meta-analysis evaluates the effect of sleep surgery on blood pressure (BP) in adults with OSA. The study protocol was registered on PROSPERO (CRD42020154425). The PubMed, MEDLINE, EMBASE, and Cochrane databases were independently searched by 2 authors up to March 2020. The keywords used were sleep apnea, OSA, sleep apnea syndromes, surgery, and BP. In 26 studies with 1218 patients (mean age: 46.2 years; 82% men), the mean AHI significantly decreased by 26.2 (95% confidence interval [CI], 21.2 to 31.1) events/hour after sleep surgery. Overall, sleep surgery resulted in a significant reduction in office systolic and diastolic BP by 5.6 mmHg (95% CI, 2.9 to 8.3) and 3.9 mmHg (95% CI, 1.8 to 6.0), respectively, in adults with OSA. According to subgroup analyses, differences in the office BP after sleep surgery were nonsignificant between regions (ie, western vs eastern countries), sample sizes, surgical procedures (ie, pharyngeal surgery vs other surgical procedures), and follow-up periods. Meta-regression analyses revealed that reductions in systolic and diastolic BP were positively correlated with the AHI reduction. In conclusion, sleep surgery significantly reduces BP and AHI in adults with OSA. The BP reduction degree after sleep surgery is positively correlated with the OSA improvement degree.

Size Effects in Internal Friction of Nanocrystalline Aluminum Films.

Al thin film is extensively used in micro-electromechanical systems (MEMS) and electronic interconnections; however, most previous research has concentrated on their quasi-static properties and applied their designs on larger scales. The present study designed a paddle-like cantilever specimen with metal films deposited on the upper surface to investigate the quasi-static properties of Al thin film at room temperature under high vacuum conditions at microscopic scales. Energy loss was determined using a decay technique in the oscillation amplitude of a vibrating structure following resonant excitation. Grain size and film thickness size were strictly controlled considering the quasi-static properties of the films. This study found that the internal friction of ultra-thin and thin Al films was more dependent on the grain boundaries than film thickness.

Effect of adenotonsillectomy on blood pressure in children with obstructive sleep apnea: a meta-analysis.

BACKGROUND: While adenotonsillectomy (T&A) is widely recognized as the first-line therapy for pediatric obstructive sleep apnea (OSA), effects of T&A on blood pressure (BP) remain unclear. This meta-analysis evaluates the associations between T&A and BP in children with OSA. METHODS: The study protocol was registered on PROSPERO (CRD42020154425). Two authors independently searched the PubMed, Medline, EMBASE, and Cochrane databases. The keywords used were "sleep apnea syndromes," "adenotonsillectomy," and "child." A random-effects model was applied to determine office systolic BP (SBP), diastolic BP (DBP), and ambulatory BP changes. RESULT: Twelve studies with 1193 children were analyzed (mean age: 7.6 y; 54% boys). The apnea-hypopnea index significantly reduced of 9.4 events/h (95% CI, -12.0 to -6.8) after T&A. Office SBP (-0.24 mmHg; 95% CI, -1.64 to 1.16) and DBP (-1.65 mmHg; 95% CI, -3.47 to 0.17) did not decrease significantly after surgery. No significant decreases were observed in 24-h ambulatory BP after T&A. Subgroup analysis showed a significant postoperative decrease in office SBP (-6.23 mmHg; 95% CI, -7.78 to -4.67) and DBP (-7.93 mmHg; 95% CI, -10.37 to -5.48) among children with hypertension but a slight increase in office SBP (2.50 mmHg; 95% CI, 1.14 to 3.86) and DBP (1.98 mmHg; 95% CI, -0.02 to 3.98) in those without (P for heterogeneity < 0.001). CONCLUSION: This meta-analysis suggests the office and ambulatory BP changes after T&A in children with OSA are trivial. Moreover, children with hypertension experience a significantly greater decrease in office BP than children without hypertension.

Measurement of Effects of Different Substrates on the Mechanical Properties of Submicron Titanium Nickel Shape Memory Alloy Thin Film Using the Bulge Test.

This study investigated the effects of different substrates on the mechanical properties of Ti-60at%Ni shape memory alloys (SMA). Two types of samples were prepared for this experiment: (1) a Ti-60at%Ni deposited on SiNx, and (2) a Ti-60at%Ni deposited on SiNx/Cr; both had a 600 nm thick film of Ti-60at%Ni. Deposition was done using the physical vapor deposition (PVD) process, and the microstructural changes and crystallization phase changes were observed through scanning electron microscopy (SEM) and X-ray diffraction (XRD). The results showed that the TiNi thin film with a Cr adhesion layer had better mechanical properties. The bulge test showed that TiNi thin film with a Cr adhesion had a higher Young's modulus and lower residual stress. From the thermal cycling experiment, it was found that the Cr adhesion layer buffered the mismatch between TiNi and SiNx. Additionally, the thermal cycling test was also used to measure the thermal expansion coefficient of the films, and the fatigue test showed that the Cr layer significantly improved the fatigue resistance of the TiNi film.

Effect of Sleep Surgery on C-Reactive Protein Levels in Adults With Obstructive Sleep Apnea: A Meta-Analysis.

OBJECTIVES/HYPOTHESIS: To evaluate associations between sleep surgery and CRP (C-reactive protein) levels in adults with obstructive sleep apnea (OSA). STUDY DESIGN: Meta-analysis. METHODS: Two authors independently searched PubMed, Medline, EMBASE, and Cochrane review databases until July 2019. The keywords used were sleep apnea, OSA, sleep apnea syndromes, surgery, C-reactive protein (CRP), and inflammatory markers. The effects of sleep surgery on CRP levels were examined using a random-effects model. RESULTS: Nine studies with 277 patients were analyzed (mean age: 46.5 years; 92% men; mean sample size: 30.8 patients). The mean change in the apnea-hypopnea index (AHI) after surgery was significantly reduced by -21.1 (95% confidence interval [CI], -28.4 to -13.7) events/hr. Overall, sleep surgery resulted in a significant reduction of CRP levels in patients with OSA (standardized mean difference [SMD] = -0.39, 95% CI, -0.67 to -0.11). Patients with postoperative AHI reduction >20 events/hr achieved a greater reduction in CRP than those with AHI reduction <20 events/hr (SMD: -0.72 vs. -0.14, P for heterogeneity = .007). According to subgroup analysis, differences in the CRP levels after surgery were nonsignificant in the different countries (i.e., United States vs. other countries), CRP types (i.e., CRP vs. high-sensitivity CRP), surgical procedures (i.e., pharyngeal surgery vs. other surgical procedures), and follow-up period (i.e., <6 vs. >6 months). CONCLUSIONS: Sleep surgery for OSA resulted in a significant reduction of CRP levels in adults. The beneficial effect of surgery on CRP levels is greater in patients with large improvement in OSA (i.e., AHI reduction >20 events/hr) after sleep surgery. Laryngoscope, 131:1180-1187, 2021.

Using Digital Image Correlation on SEM Images of Strain Field after Ion Beam Milling for the Residual Stress Measurement of Thin Films.

The residual stress of thin films during the deposition process can cause the components to have unpredictable deformation and damage, which could affect the service life and reliability of the microsystems. Developing an accurate and reliable method for measuring the residual stress of thin films at the micrometer and nanometer scale is a great challenge. To analyze the residual stress regarding factors such as the mechanical anisotropy and preferred orientation of the materials, information related to the in-depth lattice strain function is required when calculating the depth profiles of the residual strain. For depth-resolved measurements of residual stress, it is strategically advantageous to develop a measurement procedure that is microstructurally independent. Here, by performing an incremental focused ion beam (FIB) ring-core drilling experiment with various depth steps, the digital image correlation (DIC) of the specimen images was obtained. The feasibility of DIC to FIB images was evaluated after the translation test, and an appropriate procedure for reliable results was established. Furthermore, the condition of the film in the function of residual stress was assessed and compared to elucidate the applicability of this technology.

Adenotonsillectomy for the Treatment of Obstructive Sleep Apnea in Children with Prader-Willi Syndrome: A Meta-analysis.

OBJECTIVE: Adenotonsillectomy outcomes in obstructive sleep apnea (OSA) treatment among children with Prader-Willi syndrome (PWS) remain unclear. This study aimed to elucidate the effectiveness of adenotonsillectomy in OSA treatment among children with PWS. DATA SOURCE: PubMed, MEDLINE, Embase, and Cochrane Review up to February 2019. REVIEW METHODS: The registry number of the protocol published on PROSPERO was CRD42015027053. Two authors independently searched the relevant database. Polysomnography outcomes in these children were examined, including net postoperative changes in the apnea-hypopnea index (AHI), net postoperative changes in the minimum and mean oxygen saturation, the overall success rate for a postoperative AHI <1, and the overall success rate for a postoperative AHI <5. RESULTS: Six studies with 41 patients were analyzed (mean age, 5.0 years; 55% boys; mean sample size, 6.8 patients). All children had PWS and received adenotonsillectomy for the treatment of OSA. The AHI was 13.1 events per hour (95% CI, 11.0-15.1) before surgery and 4.6 events per hour (95% CI, 4.1-5.1) after surgery. The mean change in the AHI was a significant reduction of 8.0 events per hour (95% CI, -10.8 to -5.1). The overall success rate was 21% (95% CI, 11%-38%) for a postoperative AHI <1 and 71% (95% CI, 54%-83%) for a postoperative AHI <5. Some patients developed velopharyngeal insufficiency postoperatively. CONCLUSION: Adenotonsillectomy was associated with OSA improvement among children with PWS. However, residual OSA was frequently observed postoperatively in these patients.

Timely diagnosis and treatment of sleep apnea reduce cardiovascular sequelae in patients with myocardial infarction.

BACKGROUND: The present study aimed to test if the temporal sequence between sleep apnea (SA) diagnosis and incident myocardial infarction (MI) was associated with the long-term mortality and cardiovascular event in a community-based cohort. METHODS: We retrieved data from 9,453 incident MI patients between Jan. 1st 2000 and Dec. 31st 2012 from the Taiwan National Health Insurance Research Database. The study subjects included 207 MI patients with SA (SA-MI), further stratified into 110 with pre-existing SA before MI (SA-bMI) and 96 diagnosed with SA after MI (SA-pMI). The median follow-up period was 4.2 years. Propensity-score-matched controls were selected from 9,246 non-SA MI patients (non-SA-MI). The association of SA and outcomes including all-cause mortality and major adverse cardiac and cerebrovascular events (MACCEs) were analyzed by a Cox proportional hazards model. RESULTS: The result showed that SA was not associated with mortality regardless of the timing of SA diagnosis. SA-pMI was associated with increased risk of MACCEs (Hazard ratio [HR]: 1.412, 95% confidence interval [CI]: 1.037~1.923, p = 0.029) including re-MI or revascularization and ischemic heart disease hospitalization. Such an association was most significant for SA diagnosed within one year after MI (HR: 2.029, 95% CI: 1.265~3.254, p = 0.003), which was not seen in patients treated with continuous positive airway pressure (CPAP). CONCLUSION: The temporal sequence and the time interval between SA diagnosis and incident MI was associated with the cardiovascular events after MI, especially within one year after MI. Early assessment for the presence of SA after incident MI and early CPAP intervention may reduce the risk of further adverse cardiovascular events.

Prevalence of Obstructive Sleep Apnea in Children With Down Syndrome: A Meta-Analysis.

STUDY OBJECTIVES: To estimate the prevalence of obstructive sleep apnea (OSA) in children with Down syndrome. METHODS: Two authors independently searched databases, namely PubMed, MEDLINE, EMBASE, and the Cochrane Review database. The keywords used were "Down syndrome," "Trisomy 21," "OSA," "sleep apnea syndromes," "polysomnography" and "polygraphy." The prevalence of OSA based on apnea-hypopnea index (AHI) greater than 1, 1.5, 2, 5, and 10 event/h was estimated using a random-effects model. Subgroup analyses were conducted for children in different countries, sample size, study year, and risk of bias. Finally, the prevalence of OSA was compared between two types of sleep studies (polysomnography versus polygraphy). RESULTS: A total of 18 studies (1,200 children) were included (mean age: 7.7 years; 56% boys; mean sample size: 67 patients). Five studies had low risk of bias, and nine and four studies had moderate and high risk of bias, respectively. The OSA was evaluated through polygraphy in 2 studies, and polysomnography in 16 studies. For children who underwent polysomnography, the prevalences of OSA based on AHI > 1, 1.5, 2, 5, and 10 events/h were 69%, 76%, 75%, 50%, and 34%, respectively. Subgroup analyses revealed no significant difference among all subgroups. Meta-regression showed that AHI > 5 events/h was inversely correlated with age (P < .001). Moreover, the prevalence of OSA based on AHI > 1.5 events/h was lower in polygraphy compared with polysomnography (59% versus 76%, P = .037). CONCLUSIONS: OSA is highly prevalent in children with Down syndrome. Prevalence of moderate to severe OSA is higher in younger age.

Correction: Combining MAD and CPAP as an effective strategy for treating patients with severe sleep apnea intolerant to high-pressure PAP and unresponsive to MAD.

[This corrects the article DOI: 10.1371/journal.pone.0187032.].

Combining MAD and CPAP as an effective strategy for treating patients with severe sleep apnea intolerant to high-pressure PAP and unresponsive to MAD.

INTRODUCTION: This study aimed to determine the effect of combining positive airway pressure (PAP) therapy and mandibular advancement device (MAD) in patients with severe obstructive sleep apnea (OSA) who were pressure intolerant for PAP and were unresponsive to MAD. METHODS: This retrospective study reviewed the medical records of severe OSA patients with apnea-hypopnea index (AHI) ≥ 30/hr who were diagnosed between October 1, 2008 and June 30, 2014. Patients were initially treated with 2 weeks of PAP, and those who were intolerant to high-pressure PAP (≥15 cm H2O) were switched to 12 weeks of MAD, which is a monobloc designed at 75% of maximum protrusion. Patients who had high residual AHI (≥15/hr) on MAD underwent 12 weeks of combination therapy (CT) with MAD and CPAP and were enrolled in the present study. Enrolled subjects who completed the 12-week CT were followed-up until June 30, 2016. RESULTS: A total of 14 male patients were included. All three treatments effectively reduced AHI, oxygen desaturation index (ODI), and total sleep time with SpO2 <90% (% TST-SpO2<90%) compared to pretreatment values. The residual AHI and ODI on CT was lower than that on MAD or PAP. The residual % TST-SpO2<90% was lower than that on MAD and similar to that on PAP. The therapeutic pressure on CT was on average 9.2 cm H2O lower than that on PAP. For the 11 patients who completed CT, only CT reduced ESS compared to pretreatment value. No treatment had significant impact on % slow wave sleep or overnight change of blood pressure. For patients who completed CT, the average usage was 5.9±1.7 hr/night at 12th week and 6.4±1.5 hr/night at a median follow-up of 36.5-months. CONCLUSIONS: Combining MAD and CPAP showed additive effects on reducing AHI and ODI, and lowered the therapeutic pressures.

Lingual Tonsillectomy for Treatment of Pediatric Obstructive Sleep Apnea: A Meta-analysis.

Importance: Evidence indicates correlations between lingual tonsil hypertrophy and pediatric obstructive sleep apnea (OSA). However, to our knowledge, a meta-analysis of surgical outcomes for lingual tonsillectomy in children with OSA has not been conducted. Objective: To evaluate the therapeutic outcomes of lingual tonsillectomy for treatment of pediatric OSA. Data Sources: The study protocol was registered on PROSPERO (CRD42015027053). PubMed, MEDLINE, EMBASE, and the Cochrane Reviews databases were searched independently by 2 authors for relevant articles published by September 2016. Study Selection: The literature search identified English-language studies that used polysomnography to evaluate children with lingual tonsil hypertrophy and OSA after lingual tonsillectomy alone. The search keywords were lingual tonsil, lingual tonsillectomy, sleep endoscopy, sleep apnea, and child. Data Extraction and Synthesis: Polysomnographic data from each study were extracted. A random-effects model pooled postoperative sleep variable changes and success rates for lingual tonsillectomy in treating pediatric OSA. Main Outcomes and Measures: Four outcomes for lingual tonsillectomy were analyzed. These included net postoperative changes in the apnea-hypopnea index (AHI), net postoperative changes in the minimum oxygen saturation, the overall success rate for a postoperative AHI less than 1, and the overall success rate for a postoperative AHI less than 5. Results: This meta-analysis consisted of 4 studies (mean sample size, 18.25 patients), with a total of 73 unique patients (mean [SD] age, 8.3 [1.1] years). Fifty-nine percent (27 of 46) of the patients were male, and 1 of the 4 studies did not specify number of males. Lingual tonsillectomy was indicated for persistent OSA after adenotonsillectomy in all cases. Lingual tonsil hypertrophy was evaluated using computed tomography or magnetic resonance imaging in 1 study, sleep endoscopy in 2 studies, and cine magnetic resonance imaging in 1 study. The mean change in the AHI after lingual tonsillectomy was a reduction of 8.9 (95% CI, -12.6 to -5.2) events per hour. The mean change in the minimum oxygen saturation after lingual tonsillectomy was an increase of 6.0% (95% CI, 2.7%-9.2%). The overall success rate was 17% (95% CI, 7%-35%) for a postoperative AHI less than 1 and 51% (95% CI, 25%-76%) for a postoperative AHI less than 5. Postoperative complications that developed included airway obstruction, bleeding, and pneumonia. Conclusions and Relevance: Lingual tonsillectomy is an effective surgical management for children with OSA caused by lingual tonsil hypertrophy, and it achieves significant improvement in the AHI and the minimum oxygen saturation. However, children frequently have residual OSA after lingual tonsillectomy, and postoperative complications must be carefully managed.

Treatment outcomes of supraglottoplasty for pediatric obstructive sleep apnea: A meta-analysis.

OBJECTIVE: To comprehensively review changes in sleep parameters and the success rate of supraglottoplasty for treating obstructive sleep apnea (OSA) in children. In particular, to elucidate treatment modalities and factors affecting treatment outcomes in children with both laryngomalacia and OSA. METHODS: The study protocol was registered on PROSPERO (CRD42015027053). Two authors independently searched databases including PubMed, MEDLINE, EMBASE, and the Cochrane Review database. The keywords were "supraglottoplasty," "laryngomalacia," "OSA," "polysomnography," "child," and "humans." Supraglottoplasty served as the primary treatment for OSA or secondary treatment for persistent disease after previous surgeries. Subgroup analyses were conducted for children receiving supraglottoplasty as the primary or secondary treatment for OSA, and for children with and without comorbidities. RESULTS: Eleven studies with 121 patients were analyzed (mean age: 3.7 years; 64% boys; mean sample size: 11 patients). After surgery, the mean differences between the pre- and postoperative measurements were a significant reduction of 8.9 events/h in the apnea-hypopnea index (AHI) and an increase of 3.7% in minimum oxygen saturation (MinSaO2; P < 0.05). The overall success rate was 28% according to a postoperative AHI <1 and 72% according to an AHI <5. Children receiving supraglottoplasty as the primary treatment had significantly younger ages (0.6 vs 6.4 years P < 0.001) than those receiving supraglottoplasty as the secondary treatment, but the outcomes were similar (33% vs 19% for a postoperative AHI < 1, P = 0.27; 77% vs 61% for a postoperative AHI < 5, P = 0.233). Moreover, children with comorbidities, compared with those without, had a similar success rate according to a postoperative AHI <1 (25% vs 21%, P = 0.805) and postoperative AHI <5 (62% vs 84%, P = 0.166). CONCLUSIONS: Supraglottoplasty is an effective surgery for AHI reduction and MinSaO2 increase in children with OSA and laryngomalacia. However, complete resolution of OSA is not achieved in most cases, and factors affecting treatment outcomes in these children require future studies.