Is image interpretation in drug-induced sleep endoscopy that reliable?

PURPOSE: Previous studies have assessed drug-induced sleep endoscopy (DISE) as an interobserver reliable exam, with a learning curve effect. The objective was to check its assumed interobserver agreement and variability of between two groups of experienced and inexperienced French ENT physicians. METHODS: Prospective study. Seventy-six French ENT physicians (69 inexperienced in DISE and seven experienced) observed seven DISE videos. They were asked to determine the level(s), the configuration, and the degree of collapse, according to the VOTE classification. Specific and global agreements using the Fleiss' Kappa coefficient (k) were calculated. RESULTS: The interobserver agreement varied from poor to good in determining the level; the best agreement being found for the oropharynx (global agreement = 0.82 and k = 0.6 in the experienced group, global agreement = 0.87 and k = 0.7 in the inexperienced group), followed by the soft palate and the larynx; the worst agreement being found for the tongue base (k = 0.29 in the experienced group and k = 0.38 in the inexperienced group). The agreement for the configuration and the degree of collapse was moderate except for the tongue base where the concordance was poor. In both groups, agreement was at best good without any statistically significant difference between the two levels of experience groups. CONCLUSION: Even in a French ENT Sleep Experts group, DISE appears to be a technique with a limited interobserver agreement in the detection of obstructive sites, without any learning curve effect. In its current state, DISE interpretation may not be totally reliable.

Adult sleep apnea and tonsil hypertrophy: should pharyngoplasty be associated with tonsillectomy?

PURPOSE: Velopharyngoplasty and palatine tonsillectomy are at the very heart of the surgical treatment of obstructive sleep apnea syndrome (OSAS) care. In cases of major tonsil hypertrophy, we evaluated the relevance of associating soft palate surgery with palatine tonsillectomy, independent of the soft palate length. METHODS: We conducted a retrospective single-center study in OSAS patients with grade III or IV tonsils treated with tonsillectomy. Preoperative assessment included an upper airway examination performed while the patient was awake, a polysomnography and a drug-induced sedation endoscopy (DISE). Surgical efficacy was assessed on postoperative polysomnography. Success was considered when the postoperative apnea-hypopnea index (AHI) was less than 20 events/h with a 50% reduction. We compared palatine tonsillectomy efficacy alone (group A) and associated with soft palate surgery (group B). RESULTS: We analyzed 33 patients who had undergone surgery between December 2006 and May 2018. Their preoperative mean BMI and mean AHI were 27.3 ± 7.5 kg/m2 and 38.6 ± 21.4 events/h, respectively. The two groups (A, n = 18 and B, n = 15) were clinically comparable. The success rate was 72.2% in group A and 60% in group B. There was no statistically significant difference between the two groups (p > 0.1). CONCLUSIONS: According to this study, in our institution, in cases of major tonsillar hypertrophy, simultaneous soft palate surgery had no significant impact on the success rate, regardless of soft palate length. Associating soft palate surgery with palatine tonsillectomy does not seem mandatory to increase the success rate. LEVEL OF EVIDENCE: III. Retrospective comparative study.

Parafoveal and optic disc vessel density in patients with obstructive sleep apnea syndrome: an optical coherence tomography angiography study.

AIMS: To compare optic disc perfusion, radial peripapillary capillaries (RPC) and macular vascular density, between normal subjects and subjects with obstructive sleep apnea syndrome (OSAS) using spectral-domain OCT angiography (OCTA). METHODS: Sixteen eyes of patients with mild OSAS, 17 eyes with moderate OSAS, 20 eyes with severe OSAS on polygraphy and 28 controls were evaluated with OCTA RT XR Avanti (AngioVue software, Optovue Inc., Fremont, CA). Optic nerve head (ONH), RPC and macular vessel density were measured. Clinical data, visual field parameters, and Spectral Domain OCT evaluation (retinal nerve fiber layer (RNFL) thickness and ganglion cell complex (GCC) thickness) were recorded for all patients. RESULTS: ONH vascular flow (p = 0,396), RPC vascular density (automatized data "whole" p = 0,913, "peripapillary" p = 0,539, and segmented analysis with a topographic grid) and macular vascular density (foveal p = 0,484, parafoveal p = 0,491) were not significantly different between the four groups. FDT-Matrix™ and Humphrey 24/2 mean deviation were significantly lower in eyes with severe OSAS and were correlated to the apnea-hypopnea index. Retinal nerve fiber layer (RNFL) thickness, Cup/Disc ratio, rim area, and ganglion cell complex (GCC) were not significantly modified. CONCLUSIONS: OCTA did not detect reduced ONH, RPC, neither macular blood vessel density in eyes with OSAS. The precise mechanisms that link OSAS with optic nerve pathologies remain unclear: our study was not able to demonstrate a vascular impact by OCTA examination.

Are the obstruction sites visualized on drug-induced sleep endoscopy reliable?

PURPOSE: Drug-induced sleep endoscopy (DISE) has been claimed to be a reliable tool, improving surgical results in obstructive sleep apnea syndrome (OSAS). One means of assessing reliability would be to ablate only a part of the sites observed on endoscopy and find only partial success versus ablating all observed sites and finding resolution of apnea. METHODS: A retrospective study included 24 OSAS patients, operated on following awake clinical examination. DISE was performed prior to surgery. Overnight sleep study was performed before and after surgery. Two groups of patients were obtained: success (postoperative apnea-hypopnea index (AHI) <10 and >50 % reduction in preoperative AHI) and failure. Obstruction sites found on DISE and those ablated or left after surgery were compared between the two groups. RESULTS: Mean AHI fell from 30.9 ± 12.4/h to 13.7 ± 14.2/h after surgery. In eight of the 14 patients in the success group, DISE showed an obstruction site not treated by surgery. In six patients out of the ten patients in the failure group, all DISE sites were treated by surgery, which nevertheless was not effective. Four patients had retrovelar concentric obstruction. CONCLUSION: DISE could in some cases explain surgical failure. However, it also seems to show additional obstruction sites which do not need to be treated. Proper knowledge of pharyngeal fluid dynamics and mastery of the DISE technique would probably help us understand better some of the DISE findings.

Early detection of hypocalcemia after total/completion thyroidectomy: routinely usable algorithm based on serum calcium level.

BACKGROUND: The purpose of this prospective bicentric study was to investigate the course of serum calcium (Ca) and phosphorus (Phph) after total/completion thyroidectomy to establish a reliable and cost-effective strategic algorithm to detect patients at risk for postoperative hypocalcemia. METHODS: This observational study included 136 patients. Serum Ca and Phph levels were preoperatively and postoperatively recorded 6, 12, 20, and 48 h (H) after skin closure. Criteria for hypocalcemia were postoperative Ca levels ≤1.9 mmol/L at any time point and/or patients experiencing symptoms of hypocalcemia. Postoperative Ca supplementation was never given before H20 assay. Ca levels and their differences between time points were compared. RESULTS: Twenty-four percent of patients experienced hypocalcemia. At H12 and H20, the rates of patients with Ca levels ≤1.9 mmol/L were similar and larger than at H6 (p < 0.001). The H20-preoperative difference had the best area under the ROC curves (value = 0.87), and a difference ≤-0.3 was significantly more frequent in case of hypocalcemia (p = 0.001). The H20 assay and the difference H20-preop were consequently selected to design a new algorithm for hypocalcemia detection. Adding H48 assay in some specific cases (12.5 % of all included patients) enabled 100 % detection. Phosphorus assays were not informative in detecting hypocalcemia. CONCLUSIONS: This new algorithm enables, with 100 % sensitivity and 88.4 % specificity, early detection of severe hypocalcemia after total/completion thyroidectomy. It may become a useful and cost-effective tool for safe and early patient discharge, especially if PTH assays cannot be routinely used because of their availability or cost.

Is snoring intensity responsible for the sleep partner's poor quality of sleep?

PURPOSE: This study aimed to determine if the intensity of breathing noise (including snoring) and/or the presence of abnormal breathing events (ABE) are factors that trigger arousal/awakening of a snorer's bed partner. METHODS: We conducted a prospective multicenter study investigating couples where the male had a chronic disturbing snoring. We simultaneously recorded the male's respiration and snoring and the female' sleep. We counted the number of arousals and awakenings during N2 sleep and randomly took nine of each. Then, for periods before, during, and after each arousal and awakening, we observed on the respiratory tracings what was happening in terms of breathing noise intensity and presence/absence of snoring and/or ABE. RESULTS: Thirteen couples were analyzed. The intensity of breathing noise and the presence/absence of snoring and/or ABE were comparable before and at initiation of arousal/awakening and between arousal and awakening. However, breathing volume intensity was lower and the presence of snoring and/or ABE was less frequent when the bed partner returned back to sleep from awakening compared to the other periods (p always <0.001). CONCLUSIONS: The intensity of breathing noise or the presence of ABE does not seem to be essential to trigger an arousal or an awakening. However, the persistence of noise or events may prolong the duration of wakefulness during the sleep period and could be one factor that explains the bothersome snoring.

Sleep-disordered breathing: choosing the right cephalometric analysis.

PURPOSE: Cephalometry can be helpful for choosing the optimal treatment of sleep apnea. The presence or absence of maxillomandibular retrusion can contribute to the choice of treatment with an oral appliance or a skeleton-based or soft tissue surgery. To measure the position of the maxillomandibular complex, the analysis of Tweed has been cited most often. It uses dental landmarks. The analysis of Delaire relies on deeper skeletal points. The present study compared these 2 analyses for the diagnosis of maxillomandibular retrusion in a context of sleep-disordered breathing by determining the correlation between retrusion and the apnea-hypopnea index (AHI) for both methods. MATERIALS AND METHODS: A retrospective cohort study was conducted in a tertiary care university hospital. The population consisted of patients diagnosed with sleep-disordered breathing for whom polysomnographic and cephalometric data were available. Tweed and Delaire cephalometric analyses were performed for each case. The main outcome was the correlation between the degree of maxillomandibular retrusion and the AHI, as determined by Pearson coefficients. RESULTS: A total of 243 patients (42 females and 201 males) were included. For maxillary retrusion, the correlation coefficient with the AHI was -0.109 (P = .089) for Tweed and -0.160 (P = .012) for Delaire. For mandibular retrusion, the coefficient was -0.090 (P = .16) for Tweed and -0.201 (P = .002) for Delaire. Statistical significance was found only for the analysis of Delaire. CONCLUSION: The correlation between maxillomandibular retrusion and the AHI was better using the analysis of Delaire. If cephalometry is to be included in the workup of sleep-disordered breathing, the analysis of Delaire might be preferable.

[Obstructive sleep apnea syndrome]. / Syndrome d'apnées obstructives du sommeil.

Obstructive sleep apnea syndrome is a common disorder associated with potentially severe complications. Polysomnography is the gold standard diagnostic tool, while CPAP ventilation is recognized as the most efficient therapy. The numerous symptoms, even though little specific, should be rapidly detected to screen for the syndrome and transfer the patient to an adequate healthcare facility. The severity of the condition depends on the complications it causes.

Positive Impact of Genetic Test on the Management and Outcome of Patients With Paraganglioma and/or Pheochromocytoma.

CONTEXT: Pheochromocytomas and paragangliomas (PPGLs) are characterized by a strong genetic component, with up to 40% of patients carrying a germline mutation in a PPGL susceptibility gene. International guidelines recommend that genetic screening be proposed to all patients with PPGL. OBJECTIVE: Our objective was to evaluate how a positive genetic test impacts the management and outcome of patients with SDHx or VHL-related PPGL. DESIGN: We performed a multicentric retrospective study involving 221 propositi carrying an SDHB, SDHD, SDHC, or VHL germline mutation. Patients were divided into two groups: genetic patients, who were informed of their genetic status within the year following the first PPGL diagnosis, and historic patients, who only benefited from the genetic test several years after initial PPGL diagnosis. RESULTS: Genetic patients had better follow-up than historic patients, with a greater number of examinations and a reduced number of patients lost to follow-up (9.6% vs 72%, respectively). During follow-up, smaller (18.7 vs 27.6 mm; P = 0.0128) new PPGLs and metastases as well as lower metastatic spread were observed in genetic patients. Of note, these differences were reversed in the historic cohort after genetic testing. Genetic patients who developed metachronous metastases had a better 5-year survival rate than historic patients (P = 0.0127). CONCLUSION: Altogether, our data suggest that early knowledge of genetic status had a positive impact on the management and clinical outcome of patients with a germline SDHx or VHL mutation.

Comparative study of four radiofrequency generators for the treatment of snoring.

OBJECTIVE: To compare the efficacy and safety of four radiofrequency generators (Ellman, Select Sutter, Coblator, Somnus) for the treatment of simple snoring. MATERIALS AND METHODS: Multicenter, randomized, prospective single-blind study on 120 selected patients with simple snoring (apnea/hypopnea index <10/h of sleep). Snoring sound intensity was measured on a visual analog scale and the partner's short-term satisfaction rate was evaluated after two treatment sessions maximum. Discomfort, pain, and medication intake were compared. RESULTS: Radiofrequency decreased the snoring sound intensity from 7.9 +/- 1.7 to 4.4 +/- 2.7 (P < 0.0001). The four radiofrequency generators had a statistically comparable efficacy. The Ellman generator caused less discomfort and required less anti-inflammatory drugs. CONCLUSION: Despite different technical characteristics, the four generators had a comparable efficacy with good safety. The Ellman generator induced the least discomfort.

Radiofrequency tongue reduction through a cervical approach: a pilot study.

OBJECTIVE/HYPOTHESIS: The objective of this prospective cohort study was to determine the feasibility, safety, and efficacy of radiofrequency tongue base reduction through a cervical approach in patients with obstructive sleep apnea syndrome (OSAS). METHODS: Patients with moderate to severe OSAS and predominant tongue base obstruction by physical examination were included at our institution from 1999 to 2003. A sonogram was obtained to identify the lingual arteries, and an electrode was inserted through the neck and into the tongue under fluoroscopic guidance. Adverse events were recorded as well as efficacy on snoring (visual analog scale), daytime sleepiness (Epworth score), and polysomnography. RESULTS: The 10 patients received a mean of 14,288 +/- 3,251 J per session. No cases of tongue palsy or infection occurred. During the first 7 days, mean pain score (0-10 scale) was 1.3 +/- 1.5. Snoring volume (0-10 scale) decreased from 6.2 +/- 2.3 to 3.9 +/- 2.6 (P = .017) and sleepiness (0-24 scale) from 8.7 +/- 5.6 to 4.7 +/- 3.3 (P = .011). The respiratory disturbance index (events/hour) decreased from 52.0 +/- 19.6 to 33.6 +/- 24.4 (P = .016). Mean minimal oxygen saturation (%) increased from 64.2 +/- 13.0 to 75.8 +/- 10.3 (P = .003). Sleep architecture improved although not significantly. CONCLUSION: Radiofrequency tongue base reduction through a cervical approach proved feasible and safe despite the large energy doses used. Fluoroscopic guidance enables to place the electrode at the desired site of treatment. Although OSAS improved in nine of 10 patients, greater efficacy might be achieved in patients with less severe OSAS at baseline. Studies are needed to correlate objective clinical efficacy with the dose per lesion site and the number of lesion sites per session.

Comparison of negative pressure wound therapy and conventional dressing methods for fibula free flap donor site management in patients with head and neck cancer.

BACKGROUND: Evaluation of the efficacy of negative pressure wound therapy in fibula free flap donor site management in head and neck cancer. METHODS: We conducted a single-center retrospective study from 2007 to 2013 comparing fibula free flap donor site healing time after conventional bolster dressing or negative pressure wound therapy. RESULTS: Thirteen patients were treated by conventional dressing and 16 patients were treated by negative pressure wound therapy. The mean graft loss rate was higher in the bolster group (37%) than in the negative pressure wound therapy group (19%). The mean total healing time was significantly shorter in the negative pressure wound therapy group than in the bolster group (67 days vs 163 days; p = .02). CONCLUSION: The use of negative pressure wound therapy for fibula free flap donor site management facilitates early patient mobilization, ensures better graft acceptance, and significantly decreases the healing time.

Induction therapy with cetuximab plus docetaxel, cisplatin, and 5-fluorouracil (ETPF) in patients with resectable nonmetastatic stage III or IV squamous cell carcinoma of the oropharynx. A GERCOR phase II ECHO-07 study.

Induction TPF regimen is a standard treatment option for squamous cell carcinoma (SCC) of the oropharynx. The efficacy and safety of adding cetuximab to induction TPF (ETPF) therapy was evaluated. Patients with nonmetastatic resectable stage III/IV SCC of the oropharynx were treated with weekly cetuximab followed the same day by docetaxel and cisplatin and by a continuous infusion of 5-fluorouracil on days 1-5 (every 3 weeks, 3 cycles). The primary endpoint was clinical and radiological complete response (crCR) of primary tumor at 3 onths. Secondary endpoints were crCR rates, overall response, pathological CR, progression-free survival, overall survival, and safety. Forty-two patients were enrolled, and 41 received ETPF. The all nine planned cetuximab doses and the full three doses of planned chemotherapy were completed in 31 (76%) and 36 (88%) patients, respectively. Twelve (29%) patients required dose reduction. The crCR of primary tumor at the completion of therapy was observed in nine (22%) patients. ETPF was associated with a tumor objective response rate (ORR) of 58%. The most frequent grade 3-4 toxicities were as follows: nonfebrile neutropenia (39%), febrile neutropenia (19%), diarrhea (10%), and stomatitis (12%). Eighteen (44%) patients experienced acne-like skin reactions of any grade. One toxic death occurred secondary to chemotherapy-induced colitis with colonic perforation. This phase II study reports an interesting response rate for ETPF in patients with moderately advanced SCC of the oropharynx. The schedule of ETPF evaluated in this study cannot be recommended at this dosage.

Upper Airway Stimulation for Obstructive Sleep Apnea: Durability of the Treatment Effect at 18 Months.

OBJECTIVE: To determine the stability of improvement in polysomnographic measures of sleep disordered breathing, patient reported outcomes, the durability of hypoglossal nerve recruitment and safety at 18 months in the Stimulation Treatment for Apnea Reduction (STAR) trial participants. DESIGN: Prospective multicenter single group trial with participants serving as their own controls. SETTING: Twenty-two community and academic sleep medicine and otolaryngology practices. MEASUREMENTS: Primary outcome measures were the apnea-hypopnea index (AHI) and the 4% oxygen desaturation index (ODI). Secondary outcome measures were the Epworth Sleepiness Scale (ESS), the Functional Outcomes of Sleep Questionnaire (FOSQ), and oxygen saturation percent time < 90% during sleep. Stimulation level for each participant was collected at three predefined thresholds during awake testing. Procedure- and/or device-related adverse events were reviewed and coded by the Clinical Events Committee. RESULTS: The median AHI was reduced by 67.4% from the baseline of 29.3 to 9.7/h at 18 mo. The median ODI was reduced by 67.5% from 25.4 to 8.6/h at 18 mo. The FOSQ and ESS improved significantly at 18 mo compared to baseline values. The functional threshold was unchanged from baseline at 18 mo. Two participants experienced a serious device-related adverse event requiring neurostimulator repositioning and fixation. No tongue weakness reported at 18 mo. CONCLUSION: Upper airway stimulation via the hypoglossal nerve maintained a durable effect of improving airway stability during sleep and improved patient reported outcomes (Epworth Sleepiness Scale and Functional Outcomes of Sleep Questionnaire) without an increase of the stimulation thresholds or tongue injury at 18 mo of follow-up.

Tongue mechanical characteristics and genioglossus muscle EMG in obstructive sleep apnoea patients.

The increased genioglossus muscle (GGm) activity seen in obstructive sleep apnoea syndrome (OSAS) may lead to increased fatigability or longer recovery time of the tongue. Maximal force, endurance, and recovery times of the tongue, electromyogram (EMG) absolute value, and EMG spectral analysis of the GGm obtained during submaximal contractions were compared in eight individuals without chronic snoring and eight OSAS patients. Endurance time values were not significantly different between the two groups (P = 0.40). Time to recovery of initial maximal force was significantly greater in the OSAS group (P = 0.01). Final EMG median frequency was significantly higher (P = 0.01) and the final low-frequency EMG component smaller in the OSAS patients (P = 0.02). Patients did not have changes in endurance time or fatigability but had longer recovery times and changes in spectral analysis variations. This functional investigation may be helpful in determining the presence of OSAS and the potential contribution of the tongue to pharyngeal obstruction.

Pitch-raising surgery in fourteen male-to-female transsexuals.

OBJECTIVE: To evaluate the indications and results of pitch-raising surgery in male-to-female transsexual patients. STUDY DESIGN: Retrospective study of male-to-female transsexual patients who underwent pitch-raising surgery between 1994 and 2001 at a single institution. METHODS: The 14 patients had inadequate improvements after speech therapy alone. After anterior commissure advancement (n = 2), cricothyroid approximation (n = 9), or both (n = 3), results were evaluated subjectively by the patients and speech therapists and objectively by electroglottographic measurement of fundamental frequencies (usual, maximal, and minimal), postoperative gain in usual fundamental frequency, and the percentage of irregularities. RESULTS: Cricothyropexy disruption occurred in two patients. Median follow-up was 6.5 months. Subjective success rates were 78.5% and 71.5% according to the patients and speech therapists, respectively. Usual, maximal, and minimal frequencies increased significantly; median postoperative gain in usual fundamental frequency was 11 Hz. Three of the four patients with a poor objective result continued to smoke after surgery. CONCLUSION: Pitch-raising surgery induces subjective and objective improvements but should be reserved for patients in whom speech therapy is not sufficiently effective.

Radiofrequency ablation for the treatment of mild to moderate obstructive sleep apnea.

OBJECTIVES/HYPOTHESIS: Obstructive sleep apnea syndrome is due to pharyngeal obstructions, which can take place at the level of the soft palate. Temperature-controlled radiofrequency ablation has been introduced as being capable of reducing soft tissue volume and excessive compliance. The aim of the study was to evaluate prospectively the possible efficacy of temperature-controlled radiofrequency ablation applied to the soft palate in subjects with mild to moderate obstructive sleep apnea syndrome. STUDY DESIGN: Twenty-nine patients with a respiratory disturbance index between 10 and 30 events per hour, body mass index equal to or less than 30 kg/m2, and obstruction at the level of the soft palate were included in a pilot, prospective nonrandomized study. METHODS: Snoring and daytime sleepiness were evaluated subjectively. Treatment (maximum of three sessions) was discontinued when the bed partner was satisfied with the snoring level. A full night recording was performed at least 4 months after the last treatment. RESULTS: Mean snoring level decreased significantly from 8.6 +/- 1.3 to 3.3 +/- 2.5 on a visual analogue scale (0-10). Daytime sleepiness decreased nonsignificantly. Mean respiratory disturbance index decreased significantly from 19.0 +/- 6.1 events per hour to 9.8 +/- 8.6 events per hour. Mean lowest oxygen saturation value increased nonsignificantly from 85.3% +/- 4.1% to 86.4% +/- 4.4%. Of the patients, 65.5% were cured of their disease. CONCLUSIONS: Temperature-controlled radiofrequency ablation was effective in selected patients with mild to moderate obstructive sleep apnea syndrome. A full-night polysomnography is required after completion of treatment to rule out residual disease.

Endoscopic rehabilitation of vocal cord paralysis with a silicone elastomer suspension implant.

OBJECTIVES: Because of the side effects of Teflon, the risk of infection from the use of collagen, autologous fat resorption, and the lack of alternative substances, injection laryngoplasty tends to be replaced by laryngeal framework surgery as the method of choice for the treatment of unilateral vocal cord recurrent paralysis (LP). The aim of this study was to evaluate the results, for morbidity and voice quality, of treating this paralysis by injection of a silicone suspension elastomer implant (SSEI). STUDY DESIGN: The study was retrospective, and 19 patients were included. Average follow-up was 25 months (range: 8.3-43). METHODS: Each patient underwent clinical and videostroboscopic assessment, and had an electroglottographic recording. Subjective assessment was obtained by self-evaluation. Results were classified as good, fair, or poor, and were based on 2 objective and 3 subjective criteria. A search was made for biologic signs of autoimmune disorders. RESULTS: Good, fair, and poor results were respectively 79%, 16%, and 5%. Each set of subjective data showed voice improvement (P < 0.05). The fundamental frequency range, percentage of irregularity, and aspiration decreased significantly (P < 0.05). There was only one case of postoperative dyspnea, which resolved after steroid injection. No biologic signs of autoimmune disorders were found. CONCLUSIONS: The use of SSEI is safe. Injection laryngoplasty is easy to perform and avoids cervical scarring. Its results are comparable to those obtained with other techniques, including laryngeal framework surgery, even if there is no standard criterion for the evaluation of voice quality. SSEI injection can reasonably be proposed as a surgical treatment for permanent unilateral vocal cord LP.

Radiofrequency versus LAUP for the treatment of snoring.

OBJECTIVE: To compare efficacy and tolerance of controlled temperature radiofrequency and laser-assisted uvulopalatopharyngoplasty (LAUP) for the treatment of snoring. METHODS: This was a prospective, nonrandomized study on 30 patients who snored. All patients had a sleep night study. Only patients with simple snoring or mild sleep apnea and soft palate obstruction were included. Efficacy was subjectively evaluated by the bed partner 2 months after the last treatment. Tolerance was estimated daily by the patient during 18 first postoperative days. Discomfort, pain, medication intake, diet, and number of days off from work were assessed. RESULTS: Both treatments were effective on snoring. Mean discomfort and pain as well as mean intake of analgesics were significantly greater with laser-assisted uvulopalatopharyngoplasty. CONCLUSION: Controlled temperature radiofrequency was as effective as laser-assisted uvulopalatopharyngoplasty on snoring on a short-term basis but was better tolerated.

Snoring intensity after a first session of soft palate radiofrequency: predictive value of the final result.

OBJECTIVES/HYPOTHESIS: To determine whether snoring sound intensity measured after a first soft palate radiofrequency (RF) session for simple snoring helps predict the final result of the treatment. STUDY DESIGN: Observational retrospective study. METHODS: We conducted a retrospective review of 105 subjects presenting with simple snoring or mild sleep apnea. All patients underwent two to three sessions of RF-assisted stiffening of the soft palate. In addition, uvulectomy was performed in case of a long uvula, and two paramedian trenches were created in the presence of palatal webbing. Snoring sound intensity was evaluated by the bed partner after each session. RESULTS: Eighty-six men and 19 women were included in the study. Mean age was 51.7 ± 9.8 years, and mean body mass index was 24.7 ± 4.4 kg/m(2) . The mean apnea/hypopnea index was 6.6 ± 4.2/h. The mean snoring sound intensity, as evaluated on a 10-cm visual analog scale (VAS), decreased from 8.2 ± 1.5 to 3.5 ± 2.2 after all sessions (P < .0001). A score of 3 was determined as being a score that satisfied the bed partner. Two groups were formed according to the final snoring sound intensity, using 3 as a threshold. Both groups had similar preoperative characteristics, but the snoring sound intensity was significantly lower after the first session in the group with final score <3 (P = .01). Similarly, a VAS score >7 after the first session was associated with a final score <3 in 30% of the cases. CONCLUSIONS: Snoring sound intensity after the first RF session helps predict the final outcome of RF-assisted stiffening of the soft palate for simple snoring.