[Enhanced quality of documentation for biologic therapy of chronic rhinosinusitis through structured digital reporting and indication?] / Qualitätssteigerung der Dokumentation zur Biologikatherapie der chronischen Rhinosinusitis durch digitale, strukturierte Befunderhebung und Indikationsstellung?

BACKGROUND: With targeted inhibition of type 2 inflammation, biologics represent the standard add-on therapy for inadequately controlled severe forms of chronic rhinosinusitis with nasal polyps (CRSwNP). Despite standardization with paper-based checklists, the documentation of medical history and current findings pertinent to indication criteria are a significant challenge for physicians. Through development of an application based on structured reporting, the current study aimed to improve documentation quality and simplify the decision-making process. Previously available paper checklists served as a comparison. METHODS: For this study, a digital incremental tool was programmed to record current findings and check for fulfilment of indication criteria. The tool was compared with other checklists in terms of completeness, time required, and readability. RESULTS: A total of 20 findings were collected for each of the three documentation options and included in the analysis. Documentation with the two paper-based checklists had comparable information content: 17.5 ± 5.1/21.7 ± 7.6 points out of a maximum of 43 points; p > 0.05. Documentation using the digital application led to a significant increase in information content compared to all paper-based documentation. The average score was 38.25 ± 3.7 (88.9% of maximum; p < 0.001). On average, user satisfaction was high (9.6/10). Use of the digital application was initially more time consuming, but as more cases were documented, the time taken improved significantly. CONCLUSION: In the future, structured reporting using apps could replace paper-based reporting for the indication of biologic therapy in CRSwNP patients and offer additional benefits in terms of data quality and traceability of results. The increasing volume of documentation in the future, the progress of digitalization, and the possibility of networking between individual centers make introduction of the app in the near future both likely and economical.

A Narrative Review of the Association between Obstructive Sleep Apnea and Glaucoma in Adults.

BACKGROUND: Obstructive sleep apnea (OSA) is a sleep disorder, primarily of the upper airway, which not only has a significant impact on quality of life but is also associated with various systemic diseases. Several ophthalmological diseases are also associated with OSA, especially glaucoma. The purpose of this review is to take a closer look at the causality and mutual influence. METHODS: A systematic literature search was conducted using PubMed. A total of 19 studies with 316,178 adult participants were included. RESULTS: Eleven of the sixteen studies concentrating on the prevalence of glaucoma in patients with OSA showed an association of both entities. One paper found a higher risk for progression of glaucoma in OSA patients. Five of the sixteen included studies failed to show a correlation between OSA and glaucoma. One study out of three surveying specific ophthalmological parameters showed an influence of OSA therapy on retinal nerve fiber layer (RNFL) thinning and vision. One study showed a rise in intraocular pressure (IOP), while two other studies showed no increase under continuous positive airway pressure (CPAP). CONCLUSIONS: Our findings suggest an association between OSA and glaucoma and, especially, between OSA and thinning of RNFL. CPAP therapy appears to be also suitable for patients with comorbid glaucoma.

The Snoring Index Identifies Risk of Non-Alcoholic Fatty Liver Disease in Patients with Obstructive Sleep Apnea Syndrome.

BACKGROUND: The aim of this observational cohort study was to explore the severity of liver disease in patients with suspected obstructive sleep apnea in Germany. METHODS: Patients undergoing polysomnography or home sleep apnea testing (HSAT) as an evaluation for the presence of OSA were screened using vibration-controlled transient elastography (VCTE) and continuous attenuation parameter (CAP) with a Fibroscan ® Mini 430. Clinical and laboratory data were collected following the overnight exam. RESULTS: In total, 78 patients (28 female (35.9%), mean age 54.2 years) with OSA defined by an apnea-hypopnea-index >5 events/hour were included between OCT 2020 and APR 2021. Patients exhibited a high metabolic risk profile with 17% known diabetes mellitus type 2 (T2D), 62% arterial hypertension, 14% hyperlipidemia and 36% BMI > 30 kg/m2. The prevalence of steatosis defined by a CAP > 280 dB/m was 54%. The prevalence of at least significant fibrosis was 16% (E > 9.0 kPa). Interestingly, patients with a snoring index above the median of 278/h showed significantly higher CAP-values (p = 0.0002). In addition, the proportion of oxygen saturations below 90% (t90) correlated with CAP-values (p = 0.02), as well as metabolic risk factors including increased waist circumference (p = 0.005) and body mass index (BMI) (p = 0.035). On the other hand, the apnea-hypopnea-index (AHI) as a marker of OSA severity did not correlate with VCTE, CAP or laboratory parameters. CONCLUSION: Patients with moderate to severe OSA have a high prevalence of hepatic steatosis. The snoring index is an easy-to-use clinical tool to identify patients at risk for relevant liver disease within the larger group of patients with OSA.