Eustachian tube dysfunction in sleep apnea patients and improvements afforded by continuous positive airway pressure therapy

IntroductionUpper airway resistance may accompany eustachian dysfunction and alter middle ear pressure in patients with obstructive sleep apnea syndrome.ObjectiveTo investigate effects of obstructive sleep apnea syndrome and continuous positive airway pressure treatment on eustachian tube functions.MethodsForty-two mild obstructive sleep apnea syndrome patients, 45 moderate obstructive sleep apnea syndrome patients, 47 severe obstructive sleep apnea syndrome patients with continuous positive airway pressure therapy, 32 severe obstructive sleep apnea syndrome patients without continuous positive airway pressure therapy, and 88 individuals without sleep apnea (controls) were included. Tympanometric parameters of groups were compared.ResultsRight middle ear pressures in mild and moderate obstructive sleep apnea syndrome groups did not differ significantly from that of control group (p = 0.93 and p = 0.55), as was also true of the left middle ear pressures (p = 0.94 and p = 0.86). Right middle ear pressure was significantly higher in severe obstructive sleep apnea syndrome groups than in the control group, as was the left middle ear pressure (p < 0.001). Middle ear pressure (negative) was significantly lower in severe obstructive sleep apnea syndrome patients with continuous positive airway pressure therapy compared to those without (p < 0.001). Right ear type B and C tympanogram frequencies were significantly higher in patients with severe obstructive sleep apnea syndrome without continuous positive airway pressure therapy (12.4%) than in the controls (0%) (p = 0.02). Left ear type B or C tympanogram frequencies were significantly higher in patients with severe obstructive sleep apnea syndrome without continuous positive airway pressure therapy (21.9%) than in the controls (0%) (p = 0.002).ConclusionMild and moderate obstructive sleep apnea syndrome did not affect middle ear pressure but severe obstructive sleep apnea syndrome may increase the (negative) middle ear pressure. In severe obstructive sleep apnea syndrome patients, long-term continuous positive airway pressure therapy may normalize middle ear pressure.     

Effect of UPPP with respect to site of pharyngeal obstruction in sleep apnoea: follow‐up at 18 months by overnight recording of airway pressure and flow

Effect of UPPP with respect to site of pharyngeal obstruction in sleep apnoea: follow‐up at 18 months by overnight recording of airway pressure and flow Continuous recording of upper airway pressure and airflow can identify the sites of obstructive events during sleep, and their relative distribution along the upper airway segments. A separation of transpalatal and subpalatal obstructive events has been used. The purpose of the present study was to investigate if uvulopalatopharyngoplasty (UPPP) had reduced transpalatal more than subpalatal obstructive events 18 months postoperatively, and to investigate any influence of age and obesity. Fourteen consecutive male patients were investigated by overnight recording of upper airway pressure and airflow before, and 18 months after, UPPP. The localization of obstructive events pre‐ and postoperatively revealed that the proportion of obstructive events located transpalatally were reduced from 65.1 to 30.5% of all (P < 0.05). Viewing the two sites separately, the reduction in number of transpalatal events (81%) was higher than the reduction in subpalatal events (42%) (P < 0.05). Age + Body Mass Index (BMI) correlated inversely with relative reduction in subpalatal events but did not correlate to any change in transpalatal events. Treatment response with regards to reduction in recorded Apnoea Hypopnoea Index (AHI) was achieved in 9 out of the 11 patients who had mainly transpalatal obstructive events preoperatively.     

Characterization of Postoperative Edema Following Laser-Assisted Uvulopalatoplasty Using MRI and Polysomnography

Laser-assisted uvulopalatoplasty (LAUP) has been introduced as an alternative to uvulopalatopharyngoplasty for the treatment of snoring. Despite limited study, the use of this procedure has been expanded to include patients with obstructive sleep apnea syndrome. Although the potential cost-savings of performing sleep apnea surgery on an outpatient basis are self-evident, concern exists regarding the safety of this practice. In an effort to characterize the risk of performing LAUP on an outpatient basis, eight patients with mild or no sleep apnea were identified and intensively studied before and after the first stage of LAUP to cure snoring. Assessment included preoperative magnetic resonance imaging (MRI) scans, polysomnography, and videoendoscopy. Each of these diagnostic studies was then repeated between 48 and 72 hours after LAUP. Complete polysomnographic data were available for seven of the eight patients. The mean (±SD) preoperative respiratory disturbance index (RDI) was 11.3 ± 10.9, and the mean oxygen saturation nadir (LSAT) was 87.7 ± 6.2% (n = 7). The mean airway cross-sectional area at the palate (by MRI) was 49.8 ± 22.8 mm² (n = 8). After LAUP, the mean RDI nearly doubled to 21.7 ± 9.9 (P>.1). The apnea index increased fourfold from 3.3 ± 3.5 to 14.8 ± 10.9 (P<.03). The mean LSAT remained stable at 87.4 ± 4.1% (P>.5). The cross-sectional area of the airway decreased to a mean of 47.9 ± 22.4 mm² (P>.5). These data suggest that LAUP may temporarily worsen obstructive sleep apnea. Although the clinical significance of this degree of worsening is uncertain, it would be prudent to consider perioperative use of nasal continuous positive airway pressure in patients with more than mild obstructive sleep apnea who undergo ambulatory LAUP.     

腭咽成形术后咽腔与颏舌肌锻炼治疗阻塞性睡眠呼吸暂停低通气综合征的疗效观察

目的 探讨腭咽成形术后锻炼咽腔与颏舌肌对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)疗效的影响。方法 2018年1月—2020年6月将收治的80例行腭咽成形术的OSAHS患者采用数字随机表法分为两组,每组各40例;A组实施改良悬雍垂腭咽成形术治疗,B组在手术治疗基础上进行咽腔与颏舌肌锻炼,比较两组的总有效率、睡眠呼吸暂停低通气指标、睡眠状况指标及生活质量评分。结果 B组的总有效率为92.50%,高于A组75.00%(P<0.05)。治疗后,B组的夜间血氧饱和度高于A组(P<0.05),B组的低通气指数、呼吸暂停指数、呼吸暂停低通气指数均低于A组(P<0.05),B组的实际睡眠时长较A组更长(P<0.05),B组的匹兹堡睡眠质量指数(PSQI)评分较A组更低(P<0.05),B组的生活质量评分高于A组(P<0.05)。结论 在手术基础上采取咽腔与颏舌肌锻炼方法对OSAHS进行治疗可有效减轻患者夜间睡眠呼吸暂停低通气状况,改善其睡眠状况,使其生活质量提升,疗效显著。     

Esophageal Pressure Monitoring in Detection of Sleep‐Disordered Breathing

Objective The aim was to study the value of esophageal pressure monitoring combined with limited polygraphic recording (oxygen saturation, respiratory and leg movements, airflow, body position, and snoring sound) in diagnosis of sleep‐disordered breathing. Study Design A prospective study of consecutive patients with snoring was carried out. Methods Sixty‐seven patients underwent an overnight study on ward. Patients with normal oxygen desaturation index and any periodic breathing disturbances combined with elevated esophageal pressure were further studied with complete polysomnography. Results The patient compliance with esophageal catheter was 87%. Esophageal pressure monitoring increased effectively the detection of sleep‐disordered breathing with limited polygraphic recording. Sixty‐seven percent of the patients with normal oxygen desaturation index and respiratory‐related esophageal pressure variation had sleep‐disordered breathing on complete polysomnography. Increased esophageal pressure variation was significantly related with oxygen desaturation index and obstructive sleep apnea diagnosis (P <.001). All together, 48% of the mainly nonobese snorers had objective findings of sleep‐disordered breathing. Patients with upper airway resistance syndrome were few. Fifteen percent of the patients had periodic leg movements. Neither subjective or objective sleepiness nor snoring or obesity adequately exposed sleep‐disordered breathing in this material. Conclusion Esophageal pressure monitoring increases markedly the diagnostic value of limited polygraphic recording as a screening study for sleep‐disordered breathing.     

Continuous pressure measurements during sleep to localize obstructions in the upper airways in heavy snorers and patients with obstructive sleep apnea syndrome

Twenty-one patients were examined, of whom 18 suffered from obstructive sleep apnea syndrome and 3 were heavy snorers. The diagnosis was established by a combination of medical history, clinical examination and standard nocturnal polysomnography. Five pressure transducers were used in the pharynx and one in the esophagus, in addition to monitors for oxygen saturation and oro-nasal airflow. A clinically significant obstruction was defined as occurring when the pressure difference between two transducers was higher than 50% of the more caudal of the two pressures. In the 20 patients having obstructions during sleep, 7 had obstruction in only one segment of the airway, 9 in two segments and 4 in three segments. All but 2 patients had obstructions in the velopharyngeal region. Since the effect of uvulopalatopharyngoplasty (UPPP) is best during the first few months after surgery, 10 patients were re-examined after only 3 months in order to record optimal results sequentially. Of these, 6 still had obstructions involving the velopalatine segments and only 4 had none. This may explain why UPPP has a success rate of only 50–70% in most publications, depending on the definitions of success.     

How obesity affects nasal function in obstructive sleep apnea: anatomic and volumetric parameters

IntroductionObstructive sleep apnea is a consequence of upper airway collapse. Any obstructive sector in the upper airway can contribute to pharyngeal collapse. Obesity and obesity-related disorders play an important role in obstructive sleep apnea and its relationship with increased upper airway resistance.ObjectiveThis study was designed to evaluate the relationship between obesity and properties of the nasal cavity in patients with obstructive sleep apnea.MethodsThe study was conducted retrospectively by review of medical records of adult patients. The nasal obstruction symptom evaluation, NOSE instrument, was used to measure nasal obstruction. Sleep breathing disorders were evaluated by polysomnography exams. Nasal volume was obtained by computed tomography scans and volumetric reconstruction of nasal airway. Nasal anatomic alterations were assessed by nasal endoscopy.ResultsAnalysis of 83 patient records, among whom 54 were male and 29 females, found the mean body mass index of 28.69 kg/m². Obese and non-obese groups were determined by using cut-off 30 kg/m². In the comparison between groups, the obese group had a positive and significant correlation with apnea/hypopnea index (p = 0.02), NOSE instrument (p = 0.033) and inferior turbinate hypertrophy (p = 0.036), with odds ratio 1.983 (95% IC 1.048 ? 3.753). nasal septum deviation (p = 0.126) and nasal airway volume evaluation (p = 0.177) showed no significant results.ConclusionObesity was significantly correlated with subjective nasal obstruction, NOSE scale, and inferior turbinate hypertrophy in patients with obstructive sleep apnea. There was no correlation with the nasal volume evaluation.Level of Evidence3b - Individual case-control study.     

Tonsil size and body mass index are important factors for efficacy of simple tonsillectomy in obstructive sleep apnoea syndrome

Objectives: To evaluate the efficacy of simple tonsillectomy to treat obstructive sleep apnoea syndrome (OSAS) in adults. Design: Prospective study. Setting: Tertiary referral centre. Participants: Thirty patients (28 males) underwent simple tonsillectomy under general anaesthesia. The patients’ mean age was 33.2 ± 6.8 years and body mass index was 30.7 ± 6.0 kg/m². Seven patients (23%) were classified with grade 4, 16 patients (53%) with grade 3, and seven patients (23%) with grade 2 according to the tonsil size of Friedman's classification. Main outcome measures: The number of apnoea episodes per hour (apnoea index), the number of apnoea and hypopnoea episodes per hour (apnoea‐hypopnoea index), lowest nocturnal oxygen saturation and oxygen desaturation time were measured during overnight polysomnography before and after surgery. A successful tonsillectomy was defined as an apnoea–hypopnoea index improvement ratio of ≥50% and an apnoea–hypopnoea index <20 after operation. Results: Apnoea–hypopnoea index decreased from 69.0 ± 28.4/h to 30.1 ± 24.0/h (P < 0.0001). Simple tonsillectomy was successful in all six patients with body mass index <25 kg/m². Concerning success rate of simple tonsillectomy with tonsil, size 2 was lowest (42.9%). Eight of the 13 patients who used continuous positive airway pressure before simple tonsillectomy did not use continuous positive airway pressure after simple tonsillectomy because of a significant reduction of excessive daytime sleepiness. Continuous positive airway pressure decreased significantly after simple tonsillectomy from 13.6 ± 2.5 cmH₂O preoperatively to 10.6 ± 1.3 cmH₂O postoperatively (P < 0.05). Conclusions: These data suggest that simple tonsillectomy is a beneficial modality to treat OSAS in selected patients (larger tonsil, low body mass index), even in adults.     

Inflammation in the Uvula Mucosa of Patients With Obstructive Sleep Apnea

This study was conducted to determine whether inflammation is present in the uvula mucosa of patients with obstructive sleep apnea (OSA). Uvulas were obtained by uvulopalatopharyngoplasty in 21 patients with moderate OSA (mean apnea/hypopnea index and standard error of the mean: 32±4) and by autopsy in 5 individuals not known to have OSA. Using point counting in five randomly selected high-power microscopic fields (×100), the authors found that the number of leukocytes in the lamina propria of the uvula mucosa was significantly higher in patients with OSA than in the controls (179±12 cells vs. 71±4 cells, respectively;P<.05). This was due to a significant increase in the number of plasma cells in patients with OSA as compared with controls (89±15 cells vs. 21±5 cells, respectively; P<.05). The thickness of the lamina propria (an index of interstitial edema) was also significantly increased in patients with OSA compared with controls (0.99±0.12 mm vs. 0.27±0.02 mm, respectively; P<0.05). The authors conclude that inflammation, characterized by plasma cell infiltration and interstitial edema, is present in the uvula mucosa of patients with moderate OSA. They also suggest that soft palate inflammation contributes to upper airway occlusion observed during sleep in these patients.     

Retropalatal Airway Characteristics in Uvulopalatopharyngoplasty Compared With Transpalatal Advancement Pharyngoplasty

Uvulopalatopharyngoplasty (UPPP) is reported successful in treatment of obstructive sleep apnea for approximately 50% of patients. Several modifications of the procedure have been described, including transpalatal advancement pharyngoplasty, which resects a portion of posterior hard palate and advances the soft palate anteriorly. Comparing effectiveness of different techniques based on sleep and respiratory data is confounded by multiple variables including clinical failure at nonsurgical sites and imprecise patient selection techniques. Since pharyngeal surgical procedures prevent collapse and obstruction by structurally modifying the upper airway, measuring structural changes in size and collapsibility provides a method to compare techniques. To evaluate whether transpalatal advancement pharyngoplasty is more effective in modifying upper airway characteristics than UPPP, upper airway cross-sectional size and collapsibility were measured after UPPP and transpalatal advancement pharyngoplasty. Six patients were evaluated using a quantitative endoscopic technique. After transpalatal advancement pharyngoplasty maximal retropalatal airway size increased 321% from 29.7 ± 9.9 to 95.3 ± 16 mm² (P < 0.01), and retropalatal closing pressure decreased from 4.7 ± 1.6 to -3.8 ± 0.7 cm/H₂O (P < 0.01) compared with UPPP. Respiratory disturbance index decreased from 74.5 ± 13.5 to 29.2 ± 9 events/hour postoperatively (P < 0.05). Results support the conclusion that transpalatal advancement pharyngoplasty increases retropalatal size and decreases retropalatal collapsibility compared with UPPP. Since these characteristics are postulated to contribute to increased stability during sleep, transpalatal advancement pharyngoplasty may potentially improve UPPP outcome in selected patients with small retropalatal airway areas after traditional surgery.     

Physiotherapy in obstructive sleep apnea syndrome: preliminary results

Apneic patients have hypotonia of the lingual and supra-hyoid muscles. The dysfunction of theses muscles leading to a collapse of the upper airway is responsible for the apnea. The goal of this study, designed as a before-after trial, is to determine the effect of lingual and supra-hyoid muscle strengthening on obstructive sleep apnea. Thirty-four patients with obstructive sleep apnea were included (consecutive sample). Only 16 patients completed the study. The treatment consisted of 30 sessions of transcutaneous neuromuscular stimulation administered to the submental region associated with muscular exercises. The effect on apneic events was analyzed with a polysomnography before and after the treatment. Thirteen patients could be analyzed for the statistical studies. The mean apnea-hypopnea index (AHI) decreased from 32.9 to 20.6 (Wilcoxon rank test: P=0.017). Seven patients ended the study with an AHI of less than 10, and three more patients decreased their AHI by more than 50%. This treatment significantly decreased the AHI in most of the patients. A larger study with more patients and with a long-term follow-up is necessary to determine the place of physiotherapy in the treatment of obstructive sleep apnea.     

Determining the site of airway obstruction in obstructive sleep apnea with airway pressure measurements during sleep

OBJECTIVE: To determine the site(s) of upper airway obstruction in patients with obstructive sleep apnea syndrome (OSAS) and their changes during sleep with upper airway (UA) pressure measurement; and to analyze the correspondence between the UA pressure measurement and polysomnography (PSG). METHOD: Thirty patients with OSAS underwent UA pressure measurement. The catheter with five solid-state ultraminiature sensors was inserted through the patients' upper airway to the esophagus. The sensors were located at the nasopharynx, oropharynx, tongue base, hypopharynx, and esophagus. The lower limit of UA obstruction was determined by relying on the observed pressure pattern. RESULT: 1) During inspiration, obstruction occurred associated with an increased negative inspiratory pressure inferior to the site of obstruction and a disappeared negative inspiratory pressure above the site of obstruction; 2) three patterns of obstruction were observed; 3) the site of obstruction was located at the site of the palate; 4) velopharyngeal obstruction and tongue-pharynx obstruction were all present; 5) nasopharyngeal obstruction velopharyngeal obstruction and tongue-pharynx obstruction were all present; and 6) peak inspiratory pressure differences between the normal breath and apnea were associated with the longest apnea interval (P <.05). CONCLUSION: UA pressure measurement can evaluate the site of obstruction in patients with OSAS and their changes during sleep. Peak inspiratory pressure differences between normal breath and apnea can show the severity of OSAS.     

Upper airway measurements predict response to uvulopalatopharyngoplasty in obstructive sleep apnea

Although uvulopalatopharyngoplasty relieves obstructive sleep apnea in the majority of patients, the factors that determine a successful response are not well defined. To determine whether preoperative awake upper airway measurements predict the response to uvulopalatopharyngoplasty, presurgical lateral cephalometric radiographs were evaluated on 60 consecutive patients with symptomatic obstructive sleep apnea. Patients underwent overnight polysomnograms before uvulopalatopharyngoplasty and 3 months afterwards. Forty-eight (80%) patients had a good response as defined by a postoperative apnea index of less than or equal to 4 apneas/hour or a reduction in apnea index of greater than or equal to 60%. Responders had a significantly narrower inferior airway space (P less than .0005) and a smaller ratio of inferior airway space to tongue length (P less than .001). Improvement in apnea severity following uvulopalatopharyngoplasty was related to the degree of airway narrowing (r = 0.36; P less than .01). This study shows that upper airway measurements help predict response to uvulopalatopharyngoplasty in patients with obstructive sleep apnea. Patients with a narrow airway, particularly relative to tongue size, have good responses to uvulopalatopharyngoplasty.     

The use of an ambulatory,automatic sleep recording device (QUISI™ Version 1.0) in the evaluation of primary snoring and obstructive sleep apnoea

The use of an ambulatory, automatic sleep recording device (QUISI? Version 1.0) in the evaluation of primary snoring and obstructive sleep apnoea Electroencephalogram (EEG) evaluation with polysomnography (PSG) according to the Rechtschaffen & Kales (R&K) rules is time and cost consumptive, but ambulatory polygraphy systems do not allow EEG recording routinely. As a consequence, the number of sleep disordered events cannot be calculated exactly. QUISI is a one‐channel, self‐applicable ambulatory EEG recording device. The present study was designed as a prospective, non‐randomized clinical trial. This investigation evaluated the results of 40 patients with primary snoring and obstructive sleep apnoea measured with level 1 PSG and QUISI simultaneously. Fifteen patients (37.5%) were primary snorers with normal sleep profiles, whereas 25 patients (62.5%) suffered from obstructive sleep apnoea (OSA) with a Respiratory Disturbance Index (RDI) of 38.6 ± 23.8. The mean total sleeping time (TST) was underestimated by 4.5%, while Sleep Efficiency Index (SEI) was understimated by 4.6% by the QUISI device compared with PSG. The correlation between the QUISI and the PSG estimates for single sleep stages demonstrated only moderate correlation. The statistical significance for sleep stage 2 was r = 0.42, P = 0.002; for sleep stage 3/4, r = 0.31, P = 0.02; and for WAKE, r = 0.33, P = 0.01. Sleep stage 2 as well as sleep stage 3/4 were underestimated by QUISI substantially (difference: ?5.6% and ?10.3%), while WAKE was overestimated by QUISI to a larger amount (difference: +10.4%). Sensitivity and specificity of QUISI to recognize pathological sleep profiles compared with PSG/R&K were 0.92 and 0.96 respectively. QUISI is able to evaluate normal versus altered sleep profiles in patients with primary snoring and OSA. Comparing the quartile ranges, we found substantial differences between QUISI and PSG/R&K. QUISI gives an impression of sleep architecture and objective verification of a sleep disturbance in an ambulant setting but cannot replace the sleep laboratory‐based PSG.     

Polysomnographic effects of nasal surgery for snoring and obstructive sleep apnea

Objective It has been hypothesized that nasal obstruction causes an increase in negative pressure in the upper airway and induces an inspiratory collapse at the pharyngeal level. We used portable polysomnography (PSG) to assess the efficacy of nasal surgery for snoring and obstructive sleep apnea (OSA).

Material and Methods We reviewed 21 patients who presented with nasal obstruction and snoring. Septal surgery with or without inferior turbinectomy was performed. Each patient was assessed pre- and postoperatively using PSG. We measured the respiratory distress index (RDI), apnea index (AI), oxygen saturation index (OSI) and the duration of snoring. Selection criteria were an RDI of >15 as determined by PSG and clinical nasal obstruction and a deviated nasal septum as determined by physical examination.

Results Nasal surgery had the following effects: RDI decreased from 39 to 29 (p=0.0001), AI decreased from 19 to 16 (p=0.0209), OSI decreased from 48 to 32 (p=0.0001) and the duration of snoring decreased from 44% to 39% (p=0.1595). Snoring and OSA were completely relieved in 4 patients (19%) who did not require any additional surgical therapy.

Conclusion Snoring and OSA may be corrected merely by septal surgery in some patients, and secondary surgery (uvulopalatoplasty) may be considered after a thorough evaluation by means of postoperative PSG.     

CT comparison of primary snoring and obstructive sleep apnea syndrome: role of pharyngeal narrowing ratio and soft palate-tongue contact in awake patient

Soft palate-tongue contact and automatically calculated pharyngeal narrowing ratio (PNR), defined as a ratio between the airway cross-section at the hard palate level and the narrowest cross-section from the hard palate to the epiglottis, could assist in earlier identification of potential obstructive sleep apnea syndrome (OSA) patients even on awake individuals. Parameters were studied on carotid CTA images from 67 consecutively included awake Caucasians who were later classified by second independent physician into the primary snorers (SNORE, n = 34) or obstructive sleep apnea syndrome patient (OSA, n = 33) group according to the clinical examination, laboratory testing and a full-night video polysomnography (PSG) in the sleep laboratory. Imaging and clinical data were statistically compared between groups. The odd’s ratio calculation showed a 2.95 (P = 0.0354) higher risk for OSA development in snoring person with a PNR greater than 8.6. The loose-contact subgroup among OSA patients showed significantly (P = 0.002) higher values of AHI in contrast to the in-contact subgroup. Authors didn’t have any financial relationship concerning presented study.     

Laser-Assisted Uvulopalatoplasty for Obstructive Sleep Apnea

Laser-assisted uvulopalatoplasty (LAUP) can reduce snoring by sequentially removing excessive vibratory tissue of the velopharynx. The procedure can be performed under local anesthesia in an office setting. Since the appearance of the soft palate is similar after both LAUP and uvulopalatopharyngoplasty, LAUP may also be efficacious in the management of obstructive sleep apnea syndrome (OSAS). LAUP was performed in 34 consecutive prospectively evaluated patients with OSAS. Of the 34 patients, 28 (82%) were male; the mean age was 53 years, and the mean body mass index was 31.1. In the study population of 13 patients who completed preoperative and postoperative sleep studies, the apnea index decreased from 19.4 to 4.2 (P=.006), the respiratory disturbance index (RDI) decreased from 31.2 to 15.7 (P=.092), and mean lowest oxyhemoglobin saturation increased from 82.3% to 85.0% (P=.581). The RDI fell to 10 or lower in 38.5.% of patients and was reduced by at least 50% in 53.8% of the study group. Snoring was significantly reduced in 92.3% of patients (P<.001). These early results suggest that LAUP may be efficacious in the management of OSAS.     

Sleep quality after endoscopic sinus surgery in patients with sinonasal polyposis

ObjectivesEvaluate the effect of functional endoscopic sinus surgery (FESS) for nasal polyposis on sleep efficiency and polysomnographic parameters.Subjects and methodsThis clinical trial was conducted on 15 patients with bilateral massive sinonasal polyposis who underwent FESS between August 2012 and September 2013. All participants were evaluated subjectively by employing the Pittsburgh Sleep Quality Index (PSQI) questionnaire and objectively (provided by polysomnographic parameters) before and 2 months after surgery.ResultsThe evaluation of subjective criteria of sleep quality assessed by PSQI showed significant improvement, particularly in nocturnal awakening (P = 0.002). However, Apnea Hypopnea Index (AHI) was not reduced significantly after surgery (P = 0.233). Among patients who had suffered from obstructive sleep apnea, AHI was improved in 7 patients, deteriorated in 3 patients, and did not change in 1 patient. Although the mean duration of REM sleep stage increased from 15.2 ± 10.7 to 18.9 ± 7.9, this change was not statistically significant. Furthermore, arousal index decreased dramatically from 31.6 to 17.1 (P = 0.02) and sleep efficiency index was improved after the surgery (P = 0.008).ConclusionsThis study documented the effect of resuming nasal cavity patency on improvement of sleep efficiency after FESS. In spite of insignificant effect of FESS on apnea index, alteration of other sleep parameters like arousal index following surgery may have a positive effect on sleep quality.     

First-night-effect on polysomnographic respiratory sleep parameters in patients with sleep-disordered breathing and upper airway pathology

The objective of this study is to test whether there is a difference between the polysomnographic (PSG) values of Apnea–hypopnea index (AHI), minimal oxygen saturation (SpO₂), oxygen desaturation index (ODI) and arousal index recorded on two consecutive nights (so-called “first night effect”) in patients with sleep-disordered breathing (SDB) and concomitant upper airway pathology. Retrospective case–control study of polysomnographical recordings of 130 patients (112 males, 18 females, age range 23–80 years) with SDB and upper airway pathology who were tested on two consecutive nights in a hospital sleep laboratory was conducted. Only patients with upper airway pathology without other medical conditions causing SDB were included. AHI, minimal SpO₂, ODI and arousal index values of the first night were compared to those of the second night using Wilcoxon’s test. There were no significant statistical differences between AHI, SpO₂, ODI and arousal index values (P = 0.130, P = 0.640, P = 0.052, and P = 0.692, respectively) between the two nights. However, 15% of the patients showed significant variability in the AHI between the two recordings and in 6% of the patients, a diagnosis of severe OSA (AHI > 10/h) would have been missed if only one night of sleep study had been performed. In general, one night of sleep study is sufficient to lead to a clear diagnosis of severe OSA in patients with sleep-disordered breathing and upper airway pathology but may still not diagnose 6% of the patients with severe OSA. Additionally, 15% of the patients showed a significant variability in the AHI between the two nights.     

Obstructive site localization using multisensor manometry versus the Friedman staging system in obstructive sleep apnea

The aim of this study was to find the correlation between an anatomy-based staging system and pressure manometry performed during sleep. A retrospective study of 45 patients with obstructive sleep apnea (OSA) was carried out. All patients were evaluated by polysomnography, and obstruction sites were localized using a multisensor manometer during the full night. Obstruction sites were classified into retropalatal and retroglossal. The patients were also staged by anatomic findings of tonsil size and palate position. The % retroglossal obstruction was 29.4, 33.5 and 48.6% in stages I, II and III, respectively. There was no significant difference between stages. In contrast, when compared according to the Friedman tongue position (FTP), the mean % retroglossal obstruction of FTP grade 3 was significantly higher than that of FTP grade 1 (P = 0.009) although apnea hypopnea index, body mass index and lowest SpO₂ were not different among FTP grades. It seems that FTP correlates with retroglossal obstruction and may be used to select patients in need of retroglossal modification of the airway. C. H. Lee and T.-B. Won contributed equally to the content of this article.