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Williamson A, McArdle EH, Jaffal H. Findings on drug-induced sleep endoscopy in infants with laryngomalacia. Int J Pediatr Otorhinolaryngol 2024; 176:111775. [PMID: 37979251 DOI: 10.1016/j.ijporl.2023.111775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/21/2023] [Accepted: 11/03/2023] [Indexed: 11/20/2023]
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is highly prevalent in infants with laryngomalacia (LM). Previous studies have reported high rates of persistent OSA following supraglottoplasty (SGP). The objective of this study is to describe the findings on drug-induced sleep endoscopy (DISE) in infants with LM. METHODS A retrospective review was performed including infants (12.5 months of age or less) with LM who underwent DISE along with direct laryngoscopy and bronchoscopy (DLB). Data collected included clinical presentation, swallow study results, sleep study results, past medical and surgical history, and postoperative outcomes when follow-up data was available. The findings on DISE as well as DLB were reviewed and described. RESULTS Thirty-five infants were included in the study with a mean age of 0.42 years (range 0.04-1.04). Obstructive sleep-disordered breathing (oSDB) and/or OSA were identified in 26 patients (74.3%) in addition to 7 patients (20%) with noisy breathing during sleep. DISE demonstrated LM in 31 patients (89%). DISE identified 12 patients (34%) with partial or complete obstruction at the level of the tongue base. DLB identified 14 patients (40%) with a secondary airway abnormality including 7 patients (20%) with type 1 laryngeal cleft and 4 patients (11%) with grade 1 subglottic stenosis. Eighteen patients (51%) underwent SGP. CONCLUSION DISE at the time of airway endoscopy for infants with LM can be helpful in identifying additional sites of obstruction including the tongue base. Glossoptosis may explain and/or predict the previously reported persistence of OSA following SGP. Additionally, DISE can complement awake flexible laryngoscopy in the assessment of severity of LM.
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Affiliation(s)
- Adrian Williamson
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, USA
| | - Erica H McArdle
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, USA
| | - Hussein Jaffal
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, USA.
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de Castro SF, Kuhl LP, Kunde L, Manica D, Procianoy RS, Marostica PJC, Schweiger C. Endoscopic evaluation of neonates with signs of upper airway obstruction in the neonatal unit of a tertiary hospital. J Perinatol 2023; 43:1481-1485. [PMID: 37816803 DOI: 10.1038/s41372-023-01772-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 08/15/2023] [Accepted: 08/30/2023] [Indexed: 10/12/2023]
Abstract
INTRODUCTION The aim of the study is to evaluate major causes of upper airway obstruction in newborns receiving healthcare at our institution, their method of endoscopic assessment and the rate of complications related to these procedures. MATERIALS AND METHODS This is a case series study of patients from institutional neonatal intensive care unit (NICU) presenting signs of ventilatory dysfunction for whom an endoscopic airway assessment was warranted. Information of interest was collected from medical records according to a Clinical and Endoscopic Assessment Protocol created for the study. The protocol included clinical manifestations needing ENT evaluation, clinical signs of ventilatory dysfunction, comorbidities (pulmonary, cardiac, neurological, and gastrointestinal), examination method (airway endoscopy under general anesthesia or awake), exam complications, and final diagnosis. RESULTS One hundred sixty-nine newborn patients who underwent airway endoscopy (awake bedside flexible fiberoptic laryngoscopy (FFL) or direct laryngoscopy and bronchoscopy (DLB) in the surgical ward) were included. Thirty-nine patients (23.07%) underwent bedside FFL. For the remaining 130 who underwent DLB under general anesthesia, the median procedure time was 30 min (20-44). Only 9 (5.32%) patients presented complications: desaturation (4), laryngospasm without desaturation with spontaneous resolution (2), apnea with resolution after stimulation (1), seizures (1), nasal bleeding (1). The most frequent diagnoses found were glossoptosis, posterior laryngeal edema, and laryngomalacia. CONCLUSION This retrospective case series describes the prevalence of different pathologies that cause upper airway obstruction in neonates. Airway endoscopy seems an effective and safe diagnostic tool in neonatal airway obstruction. Glossoptosis was the most prevalent cause of obstruction in our center.
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Affiliation(s)
- Samantha Fernandez de Castro
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
| | - Leonardo Palma Kuhl
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Luciana Kunde
- Medical School, Universidade Luterana do Brasil (ULBRA), Canoas, Brazil
| | - Denise Manica
- Otolaryngology/Head and Neck Unit, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Renato Soibelmann Procianoy
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Neonatology Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Paulo José Cauduro Marostica
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Pediatric Pulmonology Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Cláudia Schweiger
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Otolaryngology/Head and Neck Unit, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
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Manica D, Schweiger C. The role of upper airway endoscopy in craniofacial malformations. Semin Fetal Neonatal Med 2021; 26:101293. [PMID: 34561176 DOI: 10.1016/j.siny.2021.101293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To study the role of upper airway endoscopy (UAE) in craniofacial malformations in all different management approaches described in the literature. METHODS A narrative review was performed, based on a search in pubmed. RESULTS UAE use was reviewed over five domains: 1) Diagnosis of glossoptosis and endoscopic classification: drug-induced sleep endoscopy is recommended to graduate tongue base obstruction; there is still no consensus on the graduation system to be used. 2) Airway abnormalities: there is a high incidence of additional lesions in conjunction with glossoptosis. 3) Swallowing evaluation: a formal comparison with fluoroscopy (gold standard) has not yet been performed in this population. 4) Intubation: thin bronchoscopes allow intubation of small babies; moreover, intubation with rigid video-assisted laryngoscopes show a high success rate in this population. 5) Treatment outcome monitoring: there is no consensus on the ideal parameters to be checked. CONCLUSION Some approaches have already been well established in the management of patients with craniofacial malformations, e.g. the endocopic evaluation of glossoptosis and associated lesions and its role as an intubation assistance tool, while others need to be subject of further research, e.g. its role in swallowing investigation and as a postoperative success control predictor.
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Affiliation(s)
- Denise Manica
- Otolaryngology Department, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil.
| | - Cláudia Schweiger
- Otolaryngology Department, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil; Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil.
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Duarte DW, Schweiger C, Manica D, Fagondes S, Fleith IJ, Rojas JJC, Zanin EM, Portinho CP, Collares MVM. Predictors of Respiratory Dysfunction at Diagnosis of Robin Sequence. Laryngoscope 2021; 131:2811-2816. [PMID: 34117782 DOI: 10.1002/lary.29685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/22/2021] [Accepted: 06/01/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Robin sequence (RS) consists of associated micrognathia, glossoptosis, and respiratory dysfunction, with or without cleft palate. Studies on how different patient characteristics impact the severity of respiratory dysfunction are scarce and contradictory; this study investigates how different features affect respiratory obstruction severity at diagnosis of RS in controlled analysis. STUDY DESIGN Retrospective cohort study that enrolled 71 RS patients under 90 days old who received care in our institution from 2009 to 2020. METHODS The primary outcome, respiratory dysfunction, was categorized into four severity groups and analyzed using a multinomial logistic regression model that considered age, sex, mandible length, cleft palate, syndromic diagnosis, other airway anomalies, and degree of glossoptosis. RESULTS Mandible length, syndromic diagnosis, and Yellon grade 3 glossoptosis were related to poorer respiratory outcomes (need for respiratory support). In univariate analysis, for each additional 1 mm of mandible length at diagnosis, a mean reduction of 28% in the risk of needing respiratory support was observed (OR = 0.72; 0.58-0.89); syndromic diagnosis and grade 3 glossoptosis also raised the risk (OR = 6.50; 1.59-26.51 and OR = 12.75; 1.03-157.14, respectively). In multivariate analysis, only mandible length significantly maintained its effects (OR = 0.73; 0.56-0.96), a 27% reduction. CONCLUSIONS Mandible length was an independent predictor for more severe respiratory dysfunction in RS patients, with larger mandibles showing protective effects. Syndromic diagnosis and Yellon grade 3 glossoptosis are also likely to be associated with poorer respiratory outcomes, although this was not demonstrated in multivariate analysis. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Daniele W Duarte
- Department of Plastic and Craniofacial Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Claudia Schweiger
- Department of Othorhinolaryngology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Denise Manica
- Department of Othorhinolaryngology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Simone Fagondes
- Department of Pulmonology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Iran J Fleith
- Department of Radiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Juan J C Rojas
- Department of Plastic and Craniofacial Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Eduardo M Zanin
- Department of Plastic and Craniofacial Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Ciro P Portinho
- Department of Plastic and Craniofacial Surgery, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marcus V M Collares
- Department of Plastic and Craniofacial Surgery, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Abstract
Pierre Robin sequence is defined by the clinical triad: mandibular hypoplasia, glossoptosis, and airway obstruction. Mandibular distraction osteogenesis (MDO) is a standard treatment of Robin sequence associated with severe airway obstruction and is the only intervention that directly corrects the underlying anatomic pathologic condition. Compared with tongue-lip adhesion, MDO has demonstrated more success in treating airway obstruction in infants with Pierre Robin sequence, including patients with syndromic diagnoses and concomitant anomalies. This article provides a current, comprehensive review of neonatal mandibular distraction and offers treatment guidelines based on a combined surgical experience of more than 400 patients.
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Affiliation(s)
- Kerry A Morrison
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Medical Center, 222 East 41st Street, New York, NY, 10017, USA
| | - Marcus V Collares
- Rio Grande do Sul Federal University Medical School, Hospital de Clinicas de Porto Alegre, Rio Grande do Sul Federal University, Rua Hilário Ribeiro 202, cj 406, Porto Alegre, Brazil
| | - Roberto L Flores
- Hansjörg Wyss Department of Plastic Surgery, Cleft and Craniofacial Surgery, NYU Langone Health, 222 East 41st Street, 22nd floor, New York, NY, 10017, USA.
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Kruse T, Neuschulz J, Wilhelm L, Ritgen J, Braumann B. Prenatal Diagnosis of Robin Sequence: Sensitivity, Specificity, and Clinical Relevance of an Index for Micrognathia. Cleft Palate Craniofac J 2020; 58:1012-1019. [PMID: 33228397 DOI: 10.1177/1055665620972297] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Micrognathia in connection with glossoptosis (called Robin sequence) may lead to life-threatening respiratory problems immediately after birth. An objective detection during prenatal routine ultrasound sonography is possible using an index that relates fetal lower jaw length to femur length or gestational age. The aim of this study was to test the method's sensitivity and specificity and to discuss its predictive power concerning neonatal respiratory insufficiency. DESIGN Patients with subjectively identified suspicious signs in the sagittal profile view were included in the study: Two-dimensional serial ultrasound scans of their fetal mandible were used to measure the lower jaw lengths and compare them to predicted values according to an index, derived from 313 healthy fetuses. Follow-up data provided additional information on the clinical appearance of the newborns. RESULTS The index showed a high sensitivity: 15 of the 16 cases with a micrognathia were correctly diagnosed (sensitivity of 93.75%). Follow-up data showed that newborns with similar index values differed in terms of their upper airway obstruction and treatment need. CONCLUSION Fetal mandibular micrognathia can be objectively evaluated with the help of the index. The method allows an early detection of micrognathia, which helps to take the necessary steps for proper treatment of potential life-threatening respiratory impairment. Observations ranging outside the prediction interval could prompt the ultrasonographer to check for other associated malformations.
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Affiliation(s)
- Teresa Kruse
- 14309Department of Orthodontics, University of Cologne, Cologne, Germany.,Center for Rare Diseases Cologne, University of Cologne, Cologne, Germany
| | - Julia Neuschulz
- 14309Department of Orthodontics, University of Cologne, Cologne, Germany.,Center for Rare Diseases Cologne, University of Cologne, Cologne, Germany
| | - Lucas Wilhelm
- Practice for Prenatal Diagnostics and Fetal Echocardiography, Frankfurt, Germany
| | - Jochen Ritgen
- Practice for Prenatal Medicine and Genetics, Cologne, Germany
| | - Bert Braumann
- 14309Department of Orthodontics, University of Cologne, Cologne, Germany.,Center for Rare Diseases Cologne, University of Cologne, Cologne, Germany
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Mao Z, Zhang N, Cui Y. A clinical prediction rule to identify difficult intubation in children with Robin sequence requiring mandibular distraction osteogenesis based on craniofacial CT measures. BMC Anesthesiol 2019; 19:215. [PMID: 31752712 PMCID: PMC6868728 DOI: 10.1186/s12871-019-0889-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 11/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Airway management is challenging in children with Robin sequence (RS) requiring mandibular distraction osteogenesis (MDO). We derived and validated a prediction rule to identify difficult intubation before MDO for children with RS based on craniofacial computed tomography (CT) images. METHOD This was a retrospective study of 69 children with RS requiring MDO from November 2016 to June 2018. Multiple CT imaging parameters and baseline characteristic (sex, age, gestational age, body mass index [BMI]) were compared between children with normal and difficult intubation according to Cormack-Lehane classification. A clinical prediction rule was established to identify difficult intubation using group differences in CT parameters (eleven distances, six angles, one section cross-sectional area, and three segment volumes) and clinicodemographic characteristics. Predictive accuracy was evaluated by receiver operating characteristic (ROC) curve analysis. RESULTS The overall incidence of difficult intubation was 56.52%, and there was no significant difference in sex ratio, age, weight, height, BMI, or gestational age between groups. The distance between the root of the tongue and posterior pharyngeal wall was significantly shorter, the bilateral mandibular angle shallower, and the cross-sectional area at the epiglottis tip smaller in the difficult intubation group. A clinical prediction rule based on airway cross-sectional area at the tip of the epiglottis was established. Area > 36.97 mm2 predicted difficult intubation while area < 36.97 mm2 predicted normal intubation with 100% sensitivity, 62.5% specificity, 78.6% positive predictive value, and 100% negative predictive value (area under the ROC curve = 0.8125). CONCLUSION Computed tomography measures can objectively evaluate upper airway morphology in patients with RS for prediction of difficult intubation. If validated in a larger series, the measures identified could be incorporated into airway assessment tools to guide treatment decisions. This was a retrospective study and was granted permission to access and use these medical records by the ethics committee of Guangzhou Women and Children's Medical Center. TRIALS REGISTRATION Registration No. ChiCTR1800018252, NaZhang, Sept 7 2018.
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Affiliation(s)
- Zhe Mao
- Guangzhou Women and Children's Medical Center, No 9, Jinsui Road, Guangzhou, 510623, Guangdong, China
| | - Na Zhang
- Guangzhou Women and Children's Medical Center, No 9, Jinsui Road, Guangzhou, 510623, Guangdong, China
| | - Yingqiu Cui
- Guangzhou Women and Children's Medical Center, No 9, Jinsui Road, Guangzhou, 510623, Guangdong, China.
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da Costa AL, Manica D, Schweiger C, Kuhl G, Sekine L, Fagondes SC, Collares MV, Cauduro Marostica PJ. The effect of mandibular distraction osteogenesis on airway obstruction and polysomnographic parameters in children with Robin sequence. J Craniomaxillofac Surg 2018; 46:1343-1347. [PMID: 29861406 DOI: 10.1016/j.jcms.2018.05.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/16/2018] [Accepted: 05/11/2018] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION The optimal surgical technique for the management of patients with Robin Sequence (RS) has not been established. One of the most commonly used surgical techniques, mandibular distraction osteogenesis (MDO), is still controversial because of its potential risks and the lack of clear evidence of its efficacy. OBJECTIVES To assess variations in airway patency, clinical symptoms, and polysomnographic parameters in children with RS who underwent MDO. METHODS In this prospective cohort study, 38 patients with RS were evaluated before and after MDO. Symptom severity was classified using a grading scale for RS clinical manifestations. Patients underwent flexible fiberoptic laryngoscopy, and the images were classified by a blinded examiner using two validated grading scales for airway obstruction. Patients not requiring ventilatory support underwent a polysomnography. RESULTS Patients' symptoms significantly improved after MDO, as shown by a decreased score in the grading scale for RS clinical manifestations (preoperative score of 2.20 vs. postoperative score of 0.81; P < 0.001). The two endoscopic grading scales also showed a statistically significant postoperative improvement in airway obstruction (first scale: preoperative score of 1.56 vs. postoperative score of 0.92; second scale: preoperative score of 2.19 vs. postoperative score of 1.16; P < 0.001 for both). Moreover, there was a statistically significant variation in the following polysomnographic parameters evaluated pre- and postoperatively: apnea-hypopnea index, total sleep time, oxygen desaturation nadir, and oxygen desaturation index (P < 0.05). CONCLUSIONS MDO seems to be an effective surgical option for children, as shown by postoperative improvements in clinical symptoms, endoscopic grading scales, and polysomnographic parameters.
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Affiliation(s)
- Amanda Lucas da Costa
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400, 90035-003, Porto Alegre, RS, Brazil; Otolaryngology Unit, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, 90035-903, Porto Alegre, RS, Brazil.
| | - Denise Manica
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400, 90035-003, Porto Alegre, RS, Brazil; Otolaryngology Unit, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, 90035-903, Porto Alegre, RS, Brazil.
| | - Cláudia Schweiger
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400, 90035-003, Porto Alegre, RS, Brazil; Otolaryngology Unit, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, 90035-903, Porto Alegre, RS, Brazil.
| | - Gabriel Kuhl
- Otolaryngology Unit, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, 90035-903, Porto Alegre, RS, Brazil; Department of Ophthalmology and Otolaryngology, UFRGS, Rua Ramiro Barcelos, 2400, 90035-903, Porto Alegre, RS, Brazil.
| | - Leo Sekine
- Programa de Pós-Graduação em Epidemiologia, UFRGS, Rua Ramiro Barcelos, 2400, 90035-003, Porto Alegre, RS, Brazil.
| | | | | | - Paulo Jose Cauduro Marostica
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400, 90035-003, Porto Alegre, RS, Brazil; Pediatric Pulmonology Unit, HCPA, Rua Ramiro Barcelos, 2350, 90035-903, Porto Alegre, RS, Brazil.
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Association of polysomnographic parameters with clinical symptoms severity grading in Robin sequence patients: a cohort nested cross-sectional study. Sleep Med 2018; 43:96-99. [PMID: 29482821 DOI: 10.1016/j.sleep.2017.11.1136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 10/06/2017] [Accepted: 11/05/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To evaluate the association of polysomnographic parameters with clinical symptom severity in Robin sequence (RS) patients. METHODS All patients diagnosed as presenting with RS at Hospital de Clínicas de Porto Alegre from October 2012 to June 2016 were enrolled. They were classified as isolated RS, RS-plus, and syndromic RS. Polysomnography (PSG) was performed, except for those patients in need of respiratory support. Symptom severity was evaluated as defined by the Cole et al. CLASSIFICATION Ordinal OR (for the chance of increase in one grade on the clinical severity scale) and R2 (determination coefficient from ordinal logistic regression) were computed from data analysis. RESULTS A total of 80 participants were enrolled in the study. Fifty-five of these were able to undergo polysomnography. Worsening of the studied PSG parameters was associated with increase in clinical severity grading, as follows: desaturation index (OR 1.27; 95% CI; 1.07-1.51; R2 = 19.8%; p = 0.006); apnea/hypopnea Index (OR 1.13; 95% CI; 1.01-1.26; R2 = 12.5%; p = 0.02); sleep mean oxygen saturation (OR 0.16; 95% CI; 0.05-0.52; R2 = 22.6%; p = 0.002); oxygen saturation nadir (OR 0.73; 95% CI; 0.56-0.96; R2 = 10.0%; p = 0.02); percentage of time with oxygen saturation <90% (OR 9.49; 95% CI; 1.63-55.31, R2 = 37.6%; p = 0.012); and percentage of time presenting with obstruction (OR 2.5; 95% CI; 1.31-4.76; R2 = 25.1%; p = 0.006). CONCLUSIONS Polysomnography parameters were associated with severity of clinical manifestations in patients with RS. Oxyhemoglobin saturation-based parameters had surprisingly significant R2 values. Therefore, those parameters, which have traditionally been undervalued in other clinical settings, should also be assessed in the polysomnographic evaluation of RS patients.
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Manica D, Schweiger C, Sekine L, Fagondes SC, Kuhl G, Vinicius Collares M, Marostica PJC. Diagnostic accuracy of current glossoptosis classification systems: A nested cohort cross-sectional study. Laryngoscope 2017; 128:502-508. [DOI: 10.1002/lary.26882] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 06/11/2017] [Accepted: 08/03/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Denise Manica
- Department of Otolaryngology-Head and Neck Surgery; Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente; Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
| | - Cláudia Schweiger
- Department of Otolaryngology-Head and Neck Surgery; Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente; Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
| | - Leo Sekine
- Programa de Pós-Graduação em Epidemiologia; Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
| | - Simone Chaves Fagondes
- Department of Pulmonology; Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
| | - Gabriel Kuhl
- Department of Otolaryngology-Head and Neck Surgery; Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
| | - Marcus Vinicius Collares
- Department of Surgery; Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
| | - Paulo José Cauduro Marostica
- Department of Pediatric Pulmonology; Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente; Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
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