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Suo L, Lu L, Li J, Qiu L, Liu J, Shi J, Sun Z, Lao W, Zhou X. The effect of deep and awake extubation on emergence agitation after nasal surgery: a randomized controlled trial. BMC Anesthesiol 2024; 24:177. [PMID: 38762729 PMCID: PMC11102170 DOI: 10.1186/s12871-024-02565-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 05/14/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND Post-anesthetic emergence agitation is common after general anesthesia and may cause adverse consequences, such as injury as well as respiratory and circulatory complications. Emergence agitation after general anesthesia occurs more frequently in nasal surgery than in other surgical procedures. This study aimed to assess the occurrence of emergence agitation in patients undergoing nasal surgery who were extubated under deep anesthesia or when fully awake. METHODS A total of 202 patients (18-60 years, American Society of Anesthesiologists classification: I-II) undergoing nasal surgery under general anesthesia were randomized 1:1 into two groups: a deep extubation group (group D) and an awake extubation group (group A). The primary outcome was the incidence of emergence agitation. The secondary outcomes included number of emergence agitations, sedation score, vital signs, and incidence of adverse events. RESULTS The incidence of emergence agitation was lower in group D than in group A (34.7% vs. 72.8%; p < 0.001). Compared to group A, patients in group D had lower Richmond Agitation-Sedation Scale scores, higher Ramsay sedation scores, fewer agitation episodes, and lower mean arterial pressure when extubated and 30 min after surgery, whereas these indicators did not differ 90 min after surgery. There was no difference in the incidence of adverse events between the two groups. CONCLUSIONS Extubation under deep anesthesia can significantly reduce emergence agitation after nasal surgery under general anesthesia without increasing the incidence of adverse events. TRIAL REGISTRATION Registered in Clinicaltrials.gov (NCT04844333) on 14/04/2021.
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Affiliation(s)
- Lulu Suo
- Department of Anaesthesiology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No.639 Zhizaoju Road, Shanghai, 200125, China
| | - Lu Lu
- Department of Anaesthesiology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No.639 Zhizaoju Road, Shanghai, 200125, China
| | - Jingjie Li
- Department of Anaesthesiology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No.639 Zhizaoju Road, Shanghai, 200125, China
| | - Lin Qiu
- Department of Anaesthesiology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No.639 Zhizaoju Road, Shanghai, 200125, China
| | - Jinxing Liu
- Department of Anaesthesiology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No.639 Zhizaoju Road, Shanghai, 200125, China
| | - Jinya Shi
- Department of Anaesthesiology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No.639 Zhizaoju Road, Shanghai, 200125, China
| | - Zhujie Sun
- Department of Anaesthesiology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No.639 Zhizaoju Road, Shanghai, 200125, China
| | - Wei Lao
- Department of Anaesthesiology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No.639 Zhizaoju Road, Shanghai, 200125, China.
| | - Xuhui Zhou
- Department of Anaesthesiology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No.639 Zhizaoju Road, Shanghai, 200125, China.
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Duvekot A, Klimek M, Datema FR. A critical appraisal of perioperative sleep apnoea management after nasal surgery: A review of up-to-date literature supplemented by findings of a retrospective observational study. J Perioper Pract 2024:17504589231215941. [PMID: 38205591 DOI: 10.1177/17504589231215941] [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: 01/12/2024]
Abstract
OBJECTIVE To review the current recommendations on postoperative precautions for obstructive sleep apnoea patients undergoing elective nasal surgery. DESIGN Retrospective cohort study. SETTING Department of Otorhinolaryngology and Anesthesiology/Intensive Care, University Teaching Hospital, Rotterdam, the Netherlands. PARTICIPANTS The medical charts of 61 patients with sleep apnoea who were admitted to the post-anaesthesia care unit between 2016 and 2020, following nasal surgery were reviewed. MAIN OUTCOME MEASURES Number of respiratory events during post-anaesthesia care unit admission that required medical intervention. RESULTS In all 61 patients, continuous positive airway pressure could not be used. In 13 patients (8%), decreased oxygen saturation levels were registered during the first postoperative night, and in five of these patients, supplemental oxygen was needed. No other respiratory incidents of medical interventions were registered. CONCLUSIONS The number of clinically relevant respiratory events of obstructive sleep apnoea patients with bilateral nasal packing following nasal surgery is low. We suggest that the safety of less expensive and less scarce alternatives of postoperative observation should be explored.
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Affiliation(s)
- Anne Duvekot
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Markus Klimek
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Frank R Datema
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
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3
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Giombi F, Pace GM, Pirola F, Cerasuolo M, Ferreli F, Mercante G, Spriano G, Canonica GW, Heffler E, Ferri S, Puggioni F, Paoletti G, Malvezzi L. Airways Type-2 Related Disorders: Multiorgan, Systemic or Syndemic Disease? Int J Mol Sci 2024; 25:730. [PMID: 38255804 PMCID: PMC10815382 DOI: 10.3390/ijms25020730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
Chronic rhinosinusitis (CRS) has recently undergone a significant paradigm shift, moving from a phenotypical classification towards an "endotype-based" definition that places more emphasis on clinical and therapeutic aspects. Similar to other airway diseases, like asthma, most cases of CRS in developed countries exhibit a dysregulated type-2 immune response and related cytokines. Consequently, the traditional distinction between upper and lower airways has been replaced by a "united airway" perspective. Additionally, type-2 related disorders extend beyond respiratory boundaries, encompassing conditions beyond the airways, such as atopic dermatitis. This necessitates a multidisciplinary approach. Moreover, consideration of possible systemic implications is crucial, particularly in relation to sleep-related breathing diseases like Obstructive Sleep Apnoea Syndrome (OSAS) and the alteration of systemic inflammatory mediators such as nitric oxide. The trends in epidemiological, economic, and social burden are progressively increasing worldwide, indicating syndemic characteristics. In light of these insights, this narrative review aims to present the latest evidence on respiratory type-2 related disorders, with a specific focus on CRS while promoting a comprehensive perspective on the "united airways". It also introduces a novel concept: viewing these conditions as a multiorgan, systemic, and syndemic disease.
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Affiliation(s)
- Francesco Giombi
- Otorhinolaryngology Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (F.G.); (F.P.); (M.C.); (F.F.); (G.M.); (G.S.); (L.M.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.W.C.); (E.H.); (S.F.); (F.P.); (G.P.)
| | - Gian Marco Pace
- Otorhinolaryngology Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (F.G.); (F.P.); (M.C.); (F.F.); (G.M.); (G.S.); (L.M.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.W.C.); (E.H.); (S.F.); (F.P.); (G.P.)
| | - Francesca Pirola
- Otorhinolaryngology Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (F.G.); (F.P.); (M.C.); (F.F.); (G.M.); (G.S.); (L.M.)
| | - Michele Cerasuolo
- Otorhinolaryngology Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (F.G.); (F.P.); (M.C.); (F.F.); (G.M.); (G.S.); (L.M.)
- Otorhinolaryngology Head & Neck Surgery Unit, Casa di Cura Humanitas San Pio X, Via Francesco Nava 31, 20159 Milan, Italy
| | - Fabio Ferreli
- Otorhinolaryngology Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (F.G.); (F.P.); (M.C.); (F.F.); (G.M.); (G.S.); (L.M.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.W.C.); (E.H.); (S.F.); (F.P.); (G.P.)
| | - Giuseppe Mercante
- Otorhinolaryngology Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (F.G.); (F.P.); (M.C.); (F.F.); (G.M.); (G.S.); (L.M.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.W.C.); (E.H.); (S.F.); (F.P.); (G.P.)
| | - Giuseppe Spriano
- Otorhinolaryngology Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (F.G.); (F.P.); (M.C.); (F.F.); (G.M.); (G.S.); (L.M.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.W.C.); (E.H.); (S.F.); (F.P.); (G.P.)
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.W.C.); (E.H.); (S.F.); (F.P.); (G.P.)
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Enrico Heffler
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.W.C.); (E.H.); (S.F.); (F.P.); (G.P.)
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Sebastian Ferri
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.W.C.); (E.H.); (S.F.); (F.P.); (G.P.)
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Francesca Puggioni
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.W.C.); (E.H.); (S.F.); (F.P.); (G.P.)
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Giovanni Paoletti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.W.C.); (E.H.); (S.F.); (F.P.); (G.P.)
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Luca Malvezzi
- Otorhinolaryngology Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (F.G.); (F.P.); (M.C.); (F.F.); (G.M.); (G.S.); (L.M.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.W.C.); (E.H.); (S.F.); (F.P.); (G.P.)
- Otorhinolaryngology Head & Neck Surgery Unit, Casa di Cura Humanitas San Pio X, Via Francesco Nava 31, 20159 Milan, Italy
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Pang Y, Xiao L, Liang J, Zhang F, Yao HB, Shu Y. Role of Nasal Ventilation Function in Obstructive Sleep Apnea Syndrome in Children. EAR, NOSE & THROAT JOURNAL 2023:1455613231205991. [PMID: 37864363 DOI: 10.1177/01455613231205991] [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: 10/22/2023] Open
Abstract
Background: The association between increased nasal resistance (NR) and obstructive sleep apnea syndrome (OSAS) is controversial. The purpose of this study was to examine nasal ventilation function (NVF) in children with OSAS, with a focus on its pathogenetic role. Methods: Children were recruited and divided into the OSAS group (n = 109) and control group (n = 116). The participants underwent polysomnography (PSG), measurement of NR, and acoustic rhinometry (AR). A combination of intranasal corticosteroids (ICS) and oral montelukast (OM) was administered to 90 children with mild to moderate OSAS for 12 weeks. After excluding participants who dropped out or were lost to follow-up, there were 58 children who responded to the treatment, who were divided into 2 groups-A and B. We compared the size of the tonsil adenoids, the PSG, NR, and AR before and after treatment in the 2 groups. Results: Children aged 6 to 12 years with OSAS had significantly higher NR than the control group (P < .05). The OSAS group had a smaller nasal minimal cross-sectional area (NMCA), nasal cavity volume (NCV) from 0 to 5 cm, and nasopharyngeal volume (NPV) from 6 to 8 cm than the control group, and the difference was statistically significant (P < .05 or P < .01). A total of 58 (84.1%) children responded to the 12-week ICS+OM treatment and 11 (15.9%) children did not respond to the treatment. Effective treatment was achieved in 32 children, as evidenced by a significant reduction in tonsil adenoid size and variations in NR and AR values. There were significant improvements in NR, NMCA, and NCV in the remaining 26 children who were successfully treated, but there was no change in tonsil adenoids and NPV value. Conclusion: NVF may play an important pathogenetic role in children with OSAS.
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Affiliation(s)
- Ying Pang
- Department of Otolaryngology, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Ling Xiao
- Department of Otolaryngology, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jia Liang
- Department of Otolaryngology, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Feng Zhang
- Department of Otolaryngology, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Hong-Bing Yao
- Department of Otolaryngology, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yan Shu
- Department of Otolaryngology, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
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Xu H, Shen Z, Gu Y, Hu Y, Jiang J, Li X, Zhao Y, Zhu M, Li J. Nasal splinting and mouth breathing training reduce emergence delirium after endoscopic sinus surgery: a randomized controlled trial. BMC Anesthesiol 2023; 23:302. [PMID: 37679665 PMCID: PMC10483790 DOI: 10.1186/s12871-023-02262-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 08/28/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Emergence delirium (ED) is generally occurred after anesthesia associated with increased risks of long-term adverse outcomes. Therefore, this study aimed to evaluate the efficacy of preconditioning with nasal splint and mouth-breathing training on prevention of ED after general anesthesia. METHODS This randomized controlled trial enrolled 200 adult patients undergoing ESS. Patients were randomized to receive either nasal splinting and mouth breathing training (n = 100) or standard care (n = 100) before surgery. The primary outcome was the occurrence of ED within 30 min of extubation, assessed using the Riker Sedation-Agitation Scale. Logistic regression identified risk factors for ED. RESULTS Totally 200 patients were randomized and 182 aged from 18 to 82 years with 59.9% of males were included in the final analysis (90 in C-group and 92 in P-group). ED occurred in 16.3% of the intervention group vs. 35.6% of controls (P = 0.004). Male sex, smoking and function endoscopic sinus surgery (FESS) were independent risk factors for ED. CONCLUSIONS Preoperative nasal splinting and mouth breathing training significantly reduced the incidence of emergence delirium in patients undergoing endoscopic sinus surgery. TRIAL REGISTRATION ChiCTR1900024925 ( https://www.chictr.org.cn/index.aspx ) registered on 3/8/2019.
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Affiliation(s)
- Hongjiao Xu
- Department of Anesthesiology, Shanghai General Hospital of Nanjing Medical University, 100 Haining Road, Hongkou District, Shanghai, 200080, China
| | - Zhenyuan Shen
- Department of Medical Affairs, Gumei Community Health Service Center, Shanghai Medical College Fudan University, Shanghai, China
| | - Yuyu Gu
- Department of Anesthesiology, Shanghai Jiaotong University First People's Hospital (Shanghai General Hospital), Shanghai, China
| | - Yaodan Hu
- Department of Anesthesiology, Shanghai Jiaotong University First People's Hospital (Shanghai General Hospital), Shanghai, China
| | - Jihong Jiang
- Department of Anesthesiology, Shanghai Jiaotong University First People's Hospital (Shanghai General Hospital), Shanghai, China
| | - Xiang Li
- Department of Anesthesiology, Shanghai Jiaotong University First People's Hospital (Shanghai General Hospital), Shanghai, China
| | - Yanfang Zhao
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Minmin Zhu
- Department of Anesthesiology, Shanghai Jiaotong University First People's Hospital (Shanghai General Hospital), Shanghai, China.
| | - Jinbao Li
- Department of Anesthesiology, Shanghai General Hospital of Nanjing Medical University, 100 Haining Road, Hongkou District, Shanghai, 200080, China.
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6
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Park DY, Cho JH, Jung YG, Choi JH, Kim DK, Kim SW, Kim HJ, Kim HY, Park SK, Park CS, Yang HC, Lee SH, Cho HJ. Clinical Practice Guideline: Clinical Efficacy of Nasal Surgery in the Treatment of Obstructive Sleep Apnea. Clin Exp Otorhinolaryngol 2023; 16:201-216. [PMID: 36791806 PMCID: PMC10471902 DOI: 10.21053/ceo.2022.01361] [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: 09/29/2022] [Revised: 02/05/2023] [Accepted: 02/15/2023] [Indexed: 02/16/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a common disorder characterized by upper airway obstruction during sleep. To reduce the morbidity of OSA, sleep specialists have explored various methods of managing the condition, including manifold positive airway pressure (PAP) techniques and surgical procedures. Nasal obstruction can cause significant discomfort during sleep, and it is likely that improving nasal obstruction would enhance the quality of life and PAP compliance of OSA patients. Many reliable studies have offered evidence to support this assumption. However, few comprehensive guidelines for managing OSA through nasal surgery encompass all this evidence. In order to address this gap, the Korean Society of Otorhinolaryngology-Head and Neck Surgery (KORL-HNS) and the Korean Society of Sleep and Breathing designated a guideline development group (GDG) to develop recommendations for nasal surgery in OSA patients. Several databases, including OVID Medline, Embase, the Cochrane Library, and KoreaMed, were searched to identify all relevant papers using a predefined search strategy. The types of nasal surgery included septoplasty, turbinate surgery, nasal valve surgery, septorhinoplasty, and endoscopic sinus surgery. When insufficient evidence was found, the GDG sought expert opinions and attempted to fill the evidence gap. Evidence-based recommendations for practice were ranked according to the American College of Physicians' grading system. The GDG developed 10 key action statements with supporting text to support them. Three statements are ranked as strong recommendations, three are only recommendations, and four can be considered options. The GDG hopes that this clinical practice guideline will help physicians make optimal decisions when caring for OSA patients. Conversely, the statements in this guideline are not intended to limit or restrict physicians' care based on their experience and assessment of individual patients.
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Affiliation(s)
- Do-Yang Park
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Korea
| | - Jae Hoon Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Yong Gi Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Ho Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Dong-Kyu Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Sang-Wook Kim
- Department of Otorhinolaryngology, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Hyun Jun Kim
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Korea
| | - Hyo Yeol Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Kyoung Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute for Medical Science, Chungnam National University College of Medicine, Daejeon, Korea
| | - Chan Soon Park
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyung Chae Yang
- 9Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Seung Hoon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Hyung-Ju Cho
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
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7
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Chang JL, Goldberg AN, Alt JA, Alzoubaidi M, Ashbrook L, Auckley D, Ayappa I, Bakhtiar H, Barrera JE, Bartley BL, Billings ME, Boon MS, Bosschieter P, Braverman I, Brodie K, Cabrera-Muffly C, Caesar R, Cahali MB, Cai Y, Cao M, Capasso R, Caples SM, Chahine LM, Chang CP, Chang KW, Chaudhary N, Cheong CSJ, Chowdhuri S, Cistulli PA, Claman D, Collen J, Coughlin KC, Creamer J, Davis EM, Dupuy-McCauley KL, Durr ML, Dutt M, Ali ME, Elkassabany NM, Epstein LJ, Fiala JA, Freedman N, Gill K, Boyd Gillespie M, Golisch L, Gooneratne N, Gottlieb DJ, Green KK, Gulati A, Gurubhagavatula I, Hayward N, Hoff PT, Hoffmann OM, Holfinger SJ, Hsia J, Huntley C, Huoh KC, Huyett P, Inala S, Ishman SL, Jella TK, Jobanputra AM, Johnson AP, Junna MR, Kado JT, Kaffenberger TM, Kapur VK, Kezirian EJ, Khan M, Kirsch DB, Kominsky A, Kryger M, Krystal AD, Kushida CA, Kuzniar TJ, Lam DJ, Lettieri CJ, Lim DC, Lin HC, Liu SY, MacKay SG, Magalang UJ, Malhotra A, Mansukhani MP, Maurer JT, May AM, Mitchell RB, Mokhlesi B, Mullins AE, Nada EM, Naik S, Nokes B, Olson MD, Pack AI, Pang EB, Pang KP, Patil SP, Van de Perck E, Piccirillo JF, Pien GW, Piper AJ, Plawecki A, Quigg M, Ravesloot MJ, Redline S, Rotenberg BW, Ryden A, Sarmiento KF, Sbeih F, Schell AE, Schmickl CN, Schotland HM, Schwab RJ, Seo J, Shah N, Shelgikar AV, Shochat I, Soose RJ, Steele TO, Stephens E, Stepnowsky C, Strohl KP, Sutherland K, Suurna MV, Thaler E, Thapa S, Vanderveken OM, de Vries N, Weaver EM, Weir ID, Wolfe LF, Tucker Woodson B, Won CH, Xu J, Yalamanchi P, Yaremchuk K, Yeghiazarians Y, Yu JL, Zeidler M, Rosen IM. International Consensus Statement on Obstructive Sleep Apnea. Int Forum Allergy Rhinol 2023; 13:1061-1482. [PMID: 36068685 PMCID: PMC10359192 DOI: 10.1002/alr.23079] [Citation(s) in RCA: 46] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.
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Affiliation(s)
- Jolie L. Chang
- University of California, San Francisco, California, USA
| | | | | | | | - Liza Ashbrook
- University of California, San Francisco, California, USA
| | | | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | - Maurits S. Boon
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pien Bosschieter
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Itzhak Braverman
- Hillel Yaffe Medical Center, Hadera Technion, Faculty of Medicine, Hadera, Israel
| | - Kara Brodie
- University of California, San Francisco, California, USA
| | | | - Ray Caesar
- Stone Oak Orthodontics, San Antonio, Texas, USA
| | | | - Yi Cai
- University of California, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | - Susmita Chowdhuri
- Wayne State University and John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Peter A. Cistulli
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David Claman
- University of California, San Francisco, California, USA
| | - Jacob Collen
- Uniformed Services University, Bethesda, Maryland, USA
| | | | | | - Eric M. Davis
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Mohan Dutt
- University of Michigan, Ann Arbor, Michigan, USA
| | - Mazen El Ali
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | - Kirat Gill
- Stanford University, Palo Alto, California, USA
| | | | - Lea Golisch
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | | | | | - Arushi Gulati
- University of California, San Francisco, California, USA
| | | | | | - Paul T. Hoff
- University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver M.G. Hoffmann
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | - Jennifer Hsia
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Colin Huntley
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Sanjana Inala
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Meena Khan
- Ohio State University, Columbus, Ohio, USA
| | | | - Alan Kominsky
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Meir Kryger
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Derek J. Lam
- Oregon Health and Science University, Portland, Oregon, USA
| | | | | | | | | | | | | | - Atul Malhotra
- University of California, San Diego, California, USA
| | | | - Joachim T. Maurer
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Anna M. May
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Ron B. Mitchell
- University of Texas, Southwestern and Children’s Medical Center Dallas, Texas, USA
| | | | | | | | | | - Brandon Nokes
- University of California, San Diego, California, USA
| | | | - Allan I. Pack
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | - Mark Quigg
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Armand Ryden
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Firas Sbeih
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | | | | | | | | | - Jiyeon Seo
- University of California, Los Angeles, California, USA
| | - Neomi Shah
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Ryan J. Soose
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Erika Stephens
- University of California, San Francisco, California, USA
| | | | | | | | | | - Erica Thaler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sritika Thapa
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nico de Vries
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | | | - Ian D. Weir
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Josie Xu
- University of Toronto, Ontario, Canada
| | | | | | | | | | | | - Ilene M. Rosen
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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8
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Newsome H. Evidence-Based Medicine: The Role of Nasal Surgery in Treatment of Obstructive Sleep Apnea. Facial Plast Surg 2023; 39:279-283. [PMID: 36758610 DOI: 10.1055/a-2031-3289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Nasal surgery performed for the management of obstructive sleep apnea includes septoplasty with and without inferior turbinate reduction and functional rhinoplasty. There is controversy over the effectiveness of these techniques in terms of their ability to decrease apnea-hypopnea index. However, it is fairly accepted that nasal surgery can improve sleep-related quality of life measures. This review focuses on the recently published evidence surrounding the role of nasal surgery in obstructive sleep apnea. Findings suggest that functional rhinoplasty may improve apnea-hypopnea index (AHI) in patients with mild OSA. The effect of septoplasty on AHI is less consistent. Further studies are needed to better clarify the role for both septoplasty and functional rhinoplasty in the OSA treatment algorithm.
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Affiliation(s)
- Hillary Newsome
- Department of Otolaryngology Head/Neck Surgery, UConn Health, Farmington, Connecticut
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9
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Alshehri AA, Hakami F, Gadi W, Darraj H, Hamdi S, Awaf M, Hakami A, Zogel B. Nasal Blockage and Academic Performance Among Medical College Students in the Kingdom of Saudi Arabia. Cureus 2023; 15:e36135. [PMID: 37065372 PMCID: PMC10101197 DOI: 10.7759/cureus.36135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 03/15/2023] Open
Abstract
Objectives The most frequent otolaryngological complaint is nasal obstruction. We aimed to determine if there is a relationship between nasal blockage and academic performance among medical college students in Saudi Arabia. Methods This cross-sectional survey carried out from August to December 2022, included 860 medical students determining the risk of obstructive sleep apnea (OSA) on the participants using the Berlin Sleep Questionnaire Risk Probability, then comparing it to their socio-demographic characteristics, while the Chi-square test was used for the comparison of categorical variables. Result The average age of the participants in our study was 21.52 years; 60% were females and 40% were males. The risk of obstructive sleep apnea was found to be two times higher in females than in males (95% CI: 1.195- 3.345; p-value 0.008). The hypertensive participants had a 27-fold increased risk of OSA compared to non-hypertensives. Grade Point Average (GPA) and snoring had a statistically significant relationship, however, a fifth of the participants reported snoring (79.8% reported not snoring). We also found that 14.8% of the participants with snoring had a GPA between 2-4.49 compared to 44.6% of participants without snoring. Conclusion Female students had a two-fold higher chance of developing OSA than males. While a GPA of 4.5 and above was more often associated with participants without snoring, the number of individuals with a GPA of 2-4.49 was greater among participants with snoring. To aid in the prevention of illness complications and the management of risk factors, additional efforts should be made to increase disease knowledge among students, primary healthcare practitioners, and specialty doctors.
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10
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Guan S, Zhao T, Ye J, Zhang J. Influence of bilateral nasal packing on sleep oxygen saturation after general anesthesia: A prospective cohort study. Front Surg 2023; 10:1083961. [PMID: 36793309 PMCID: PMC9922837 DOI: 10.3389/fsurg.2023.1083961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/02/2023] [Indexed: 01/31/2023] Open
Abstract
Objective This study aims to evaluate the effect of bilateral nasal packing on sleep oxygen saturation and its influencing factors on the first night after general anesthesia. Method A total of 36 adult patients who underwent bilateral nasal packing with a nonabsorbable expanding sponge after general anesthesia surgery were prospectively studied. All these patients underwent overnight oximetry tests before and the first night after surgery. The following oximetry variables were collected for analysis: the lowest oxygen saturation (LSAT), the average oxygen saturation (ASAT), the oxygen desaturation index of ≥4% (ODI4), and the percentage of time with oxygen saturation below 90% (CT90). Results Among the 36 patients, the incidences of both sleep hypoxemia and moderate-to-severe sleep hypoxemia increased with bilateral nasal packing after general anesthesia surgery. All the pulse oximetry variables we studied deteriorated significantly after surgery: both LSAT and ASAT decreased significantly (P < 0.05), while both ODI4 and CT90 increased significantly (P < 0.05). In a multiple logistic regression analysis, body mass index (BMI), LSAT, and modified Mallampati grade were found to be independently predictive for a larger decrease in LSAT (≥5%) after surgery (all P's < 0.05). Conclusion Bilateral nasal packing after general anesthesia could induce or aggravate sleep hypoxemia, especially in patients with obesity, relatively normal sleep oxygen saturation, and high modified Mallampati grades.
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Affiliation(s)
- Shuwen Guan
- Department of Otolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, China,Department of Otorhinolaryngology, Head and Neck Surgery, Shenzhen University General Hospital, Shenzhen, China
| | - Tingting Zhao
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Jingying Ye
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China,Correspondence: Junbo Zhang Jingying Ye
| | - Junbo Zhang
- Department of Otolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, China,Department of Otolaryngology, Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China,Correspondence: Junbo Zhang Jingying Ye
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11
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Hu B, Yin G, Fu S, Zhang B, Shang Y, Zhang Y, Ye J. The influence of mouth opening on pharyngeal pressure loss and its underlying mechanism: A computational fluid dynamic analysis. Front Bioeng Biotechnol 2023; 10:1081465. [PMID: 36698641 PMCID: PMC9868155 DOI: 10.3389/fbioe.2022.1081465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
Objective: During inspiration, mechanical energy generated from respiratory muscle produces a negative pressure gradient to fulfill enough pulmonary ventilation. The pressure loss, a surrogate for energy loss, is considered as the portion of negative pressure without converting into the kinetic energy of airflow. Mouth opening (MO) during sleep is a common symptom in patients with obstructive sleep apnoea-hypopnea syndrome (OSAHS). This study aimed to evaluate the effects of mouth opening on pharyngeal pressure loss using computational fluid dynamics (CFD) simulation. Methods: A total of four subjects who were morphologically distinct in the pharyngeal characteristics based on Friedman tongue position (FTP) grades were selected. Upper airway computed tomography (CT) scan was performed under two conditions: Mouth closing (MC) and mouth opening, in order to reconstruct the upper airway models. computational fluid dynamics was used to simulate the flow on the two different occasions: Mouth closing and mouth opening. Results: The pharyngeal jet was the typical aerodynamic feature and its formation and development were different from mouth closing to mouth opening in subjects with different Friedman tongue position grades. For FTP I with mouth closing, a pharyngeal jet gradually formed with proximity to the velopharyngeal minimum area plane (planeAmin). Downstream the planeAmin, the jet impingement on the pharyngeal wall resulted in the frictional loss associated with wall shear stress (WSS). A rapid luminal expansion led to flow separation and large recirculation region, corresponding to the interior flow loss. They all contributed to the pharyngeal total pressure loss. While for FTP I with mouth opening, the improved velopharyngeal constriction led to smoother flow and a lower total pressure loss. For FTP IV, the narrower the planeAmin after mouth opening, the stronger the jet formation and its impingement on the pharyngeal wall, predicting a higher frictional loss resulted from higher WSS. Besides, a longer length of the mouth opening-associated constant constrictive segment was another important morphological factor promoting frictional loss. Conclusion: For certain OSAHS patients with higher Friedman tongue position grade, mouth opening-related stronger jet formation, more jet breakdown and stronger jet flow separation might contribute to the increased pharyngeal pressure loss. It might require compensation from more inspiratory negative static pressure that would potentially increase the severity of OSAHS.
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Affiliation(s)
- Bin Hu
- Department of Otolaryngology-Head Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Guoping Yin
- Department of Otolaryngology-Head Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China,Sleep Medicine Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Song Fu
- School of Aeronautics and Astronautics, Tsinghua University, Beijing, China
| | - Baoshou Zhang
- School of Aeronautics and Astronautics, Tsinghua University, Beijing, China
| | - Yan Shang
- School of Aeronautics and Astronautics, Tsinghua University, Beijing, China
| | - Yuhuan Zhang
- Sleep Medicine Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Jingying Ye
- Department of Otolaryngology-Head Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China,Sleep Medicine Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China,*Correspondence: Jingying Ye,
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12
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Schoustra E, van Maanen P, den Haan C, Ravesloot MJL, de Vries N. The Role of Isolated Nasal Surgery in Obstructive Sleep Apnea Therapy-A Systematic Review. Brain Sci 2022; 12:1446. [PMID: 36358372 PMCID: PMC9688553 DOI: 10.3390/brainsci12111446] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/20/2022] [Accepted: 10/23/2022] [Indexed: 11/25/2023] Open
Abstract
Nasal obstruction is believed to play a significant role in the pathophysiology and management of obstructive sleep apnea (OSA). However, controversy remains about the ability of isolated nasal surgery to improve OSA. The objective of this systematic review is to give an updated overview of the literature on whether isolated nasal surgery can improve OSA subjectively (Epworth Sleepiness Scale (ESS)) and/or objectively (polysomnography (PSG)). Methods: A systematic review was performed searching the electronic databases PubMed, Embase.com (accessed on 20 June 2022) Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials (CENTRAL) up to 20 June 2022. Eligible studies were reviewed for methodological quality using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Results: Twenty-one studies met the inclusion criteria. The majority of the included studies reported no significant reduction in the apnea-hypopnea index (AHI) after isolated nasal surgery in patients with OSA. The meta-analysis suggests that the AHI slightly decreases after nasal surgery. The ESS was significantly lower after nasal surgery in eighteen studies. Conclusion: Based on the present analysis of objective outcomes, isolated nasal surgery did not improve the AHI significantly in the majority of the studies. The meta-analysis suggests a slight decrease in AHI after nasal surgery, but this reduction is not clinically relevant in terms of treatment success. Isolated nasal surgery should therefore not be recommended as a first-line treatment for OSA. Because of high study heterogeneity, these results should be interpreted with caution. Isolated nasal surgery can possibly improve OSA subjectively. Perhaps only OSA patients with complaints of nasal obstruction or OSA patients experiencing difficulty with continuous positive airway pressure (CPAP) compliance would benefit from isolated nasal surgery.
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Affiliation(s)
- Emily Schoustra
- Department of Otorhinolaryngology—Head and Neck Surgery, OLVG, 1061 AE Amsterdam, The Netherlands
| | - Peter van Maanen
- Department of Otorhinolaryngology—Head and Neck Surgery, OLVG, 1061 AE Amsterdam, The Netherlands
| | - Chantal den Haan
- Department of Research and Epidemiology, Medical Library, OLVG, 1061 AE Amsterdam, The Netherlands
| | - Madeline J. L. Ravesloot
- Department of Otorhinolaryngology—Head and Neck Surgery, OLVG, 1061 AE Amsterdam, The Netherlands
| | - Nico de Vries
- Department of Otorhinolaryngology—Head and Neck Surgery, OLVG, 1061 AE Amsterdam, The Netherlands
- Department of Oral Kinesiology, Academisch Centrum Tandheelkunde Amsterdam, MOVE Research Institute Amsterdam, University of Amsterdam and VU Amsterdam, 1081 LA Amsterdam, The Netherlands
- Faculty of Medicine and Health Sciences, Department of Otorhinolaryngology, Head and Neck Surgery Antwerp University Hospital, 2650 Antwerp, Belgium
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13
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Suzuki M, Kawai K, Kawai Y, Honjo M, Furukawa T. Preoperative apnea-hypopnea index predicts increased postoperative intrathoracic pressure during sleep in patients who underwent endoscopic nasal surgery. Auris Nasus Larynx 2022; 49:805-809. [PMID: 35184923 DOI: 10.1016/j.anl.2022.02.001] [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: 09/15/2021] [Revised: 01/09/2022] [Accepted: 02/02/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Respiratory condition could worsen during sleep in patients with nasal packing following endoscopic nasal and sinus surgery (ESS) under general anesthesia. Recently, a noninvasive intrathoracic pressure estimation sensor was developed that uses photoplethysmographic pulse wave technology. The purpose of this study was to noninvasively evaluate the effect of bilateral nasal packing on respiration during sleep, using a photoplethysmographic pulse wave sensor in perioperative patients who underwent ESS under general anesthesia. METHODS In this observational cross-sectional case-control study, estimated intrathoracic pressure and SpO2 were noninvasively measured during sleep with a wristband-type photoplethysmographic pulse wave sensor and a pulse oximeter in 43 patients with chronic sinusitis, nasal allergy, or septal deviation who underwent bilateral ESS under general anesthesia. Measurements were taken preoperatively, at postoperative day 1 (POD1) with bilateral nasal packing in place, and at POD5 after the nasal packing was removed. Based on the preoperative obstructive apnea-hypopnea index (AHI) score determined by overnight polysomnography, patients were classified into those with moderate to severe obstructive sleep apnea (OSA) (AHI ≥ 15/h) and those with mild or non-OSA (AHI ≤ 15/h). RESULTS Significant changes were noted in estimated intrathoracic pressure, but not in SpO2 nadir, between time points. Estimated intrathoracic pressure decreased the most at POD1 with bilateral nasal packing in place in patients with OSA after ESS. Multivariate stepwise regression revealed the relative incidence of increased estimated intrathoracic pressure on POD1 was independently predicted by preoperative AHI, but not by age, body mass index, total nasal resistance, or preoperative SpO2 nadir. CONCLUSION Use of the photoplethysmographic pulse wave sensor to noninvasively measure intrathoracic pressure detected changes in perioperative respiratory effort that pulse oximetry did not. Attention should be paid to the use of postoperative bilateral nasal packing in patients with moderate to severe OSA who undergo ESS under general anesthesia. Our results support the concept of using less, short-term, or no nasal packing after ESS.
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Affiliation(s)
| | - Kaori Kawai
- Laboratory Medicine, Teikyo University Chiba Medical Center, Chiba, Japan
| | | | | | - Taiji Furukawa
- Department of Laboratory Medicine, Teikyo University School of Medicine, Tokyo, Japan
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14
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Ersözlü T, Deniz M, Fazlıoglu N, Gultekin E, Altintas N. Understanding potential associations between anatomic and other factors in OSA severity. Sleep Breath 2021; 26:1649-1653. [PMID: 34841491 DOI: 10.1007/s11325-021-02539-1] [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: 07/09/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this prospective study was to investigate associations between nasal/oropharyngeal structures and a range of factors including age, gender, daytime sleepiness, and body mass index (BMI). METHODS Patients with OSA were prospectively selected as research participants in rhinomanometric analysis as well as for otolaryngological evaluation. Participants were grouped as follows according to their apnea/hypopnea index (AHI) scores: no OSA (AHI < 5), mild OSA (5 ≤ AHI ≤ 15), moderate OSA (15 ≤ AHI < 30), and severe OSA (AHI ≥ 30). One-way analysis of variance (ANOVA), Kruskal-Wallis H, and Mann-Whitney U tests were performed to assess OSA severity in terms of the relationships between nasal resistance (NR) and anthropometric indices (body mass index (BMI), Friedman tongue position (FTP)), age, and gender. RESULTS The study cohort of 177 men and 81 women ranged in age between 21 and 76 years, with BMI ranging from 23 to 45. In total, 37 patients were simple snorers (AHI < 5), and 221 patients were diagnosed with OSA. There was no significant difference among the AHI groups in terms of nasal volume (Vol05) (p = 0.952), mean flow (p = 0.778), and mean NR total (p = 0.723). A statistically significant difference was found between the AHI groups in terms of mean BMI and median FTP scores (p < 0.001). CONCLUSION This study provides evidence that that the oropharyngeal region (oropharynx, tongue, and vallecula) is a more important determinant of OSA severity than the nasal region.
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Affiliation(s)
- Tolga Ersözlü
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Namık Kemal University, Namık Kemal Mah. Kampüs cad. No:1/14 Sağlık Uygulama ve Araştırma Merkezi, 59100, SüleymanPaşa/Tekirdağ, Turkey.
| | - Mahmut Deniz
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Namık Kemal University, Namık Kemal Mah. Kampüs cad. No:1/14 Sağlık Uygulama ve Araştırma Merkezi, 59100, SüleymanPaşa/Tekirdağ, Turkey
| | - Nevin Fazlıoglu
- Department of Pulmonary Medicine, Namık Kemal University, Tekirdağ, Turkey
| | - Erdogan Gultekin
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Namık Kemal University, Namık Kemal Mah. Kampüs cad. No:1/14 Sağlık Uygulama ve Araştırma Merkezi, 59100, SüleymanPaşa/Tekirdağ, Turkey
| | - Nejat Altintas
- Department of Pulmonary Medicine, Namık Kemal University, Tekirdağ, Turkey
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15
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Relationship between allergic rhinitis and nasal surgery success in patients with obstructive sleep apnea. Am J Otolaryngol 2021; 42:103079. [PMID: 34020179 DOI: 10.1016/j.amjoto.2021.103079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/09/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Nasal obstruction is common in patients with obstructive sleep apnea (OSA). Nonetheless, the effectiveness of isolated nasal surgery in treatment of OSA remains controversial. This study is to evaluate the subjective and objective outcome after isolated nasal surgery in patients with OSA and to determine the associated factors related to the success rate of isolated nasal surgery. METHODS The study population consisted of 35 patients with nasal obstruction who had been diagnosed with OSA and were undergoing septoplasty and inferior turbinate reduction to correct nasal pathologies. Preoperative drug-induced sleep endoscopy was performed to evaluate the obstruction site. Patients were assessed before and after nasal surgery using subjective outcomes measures, including the Visual Analog Scale and Epworth Sleepiness Scale, as well as by overnight polysomnography. RESULTS All patients experienced improved nasal breathing postoperatively. At 6 months postoperatively, patients exhibited significant symptomatic improvement in snoring, sleep apnea, morning headache, tiredness, and daytime sleepiness. Postoperative polysomnography revealed significant improvement in the apnea-hypopnea index, respiratory disturbance index, and percentage of time with oxygen saturation < 90%. Although the overall success rate of nasal surgery alone was 14.3%, the criteria for success were met in 50% of patients with allergic rhinitis. Furthermore, the success rate was significantly higher in patients with moderate to severe nasal obstruction than in patients with mild nasal obstruction. CONCLUSION Among patients with OSA, those with allergic rhinitis and severe nasal obstruction are likely to have a better surgical outcome following isolated nasal surgery.
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16
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Li L, Han D, Zang H, London NR. Aerodynamics Analysis of the Impact of Nasal Surgery on Patients with Obstructive Sleep Apnea and Nasal Obstruction. ORL J Otorhinolaryngol Relat Spec 2021; 84:62-69. [PMID: 34058743 DOI: 10.1159/000516243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 03/26/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the effects of nasal surgery on airflow characteristics in patients with obstructive sleep apnea (OSA) by comparing the alterations of airflow characteristics within the nasal and palatopharyngeal cavities. METHODS Thirty patients with OSA and nasal obstruction who underwent nasal surgery were enrolled. A pre- and postoperative 3-dimensional model was constructed, and alterations of airflow characteristics were assessed using the method of computational fluid dynamics. The other subjective and objective clinical indices were also assessed. RESULTS By comparison with the preoperative value, all postoperative subjective symptoms statistically improved (p < 0.05), while the Apnea-Hypopnea Index (AHI) changed little (p = 0.492); the postoperative airflow velocity and pressure in both nasal and palatopharyngeal cavities, nasal and palatopharyngeal pressure differences, and total upper airway resistance statistically decreased (all p < 0.01). A significant difference was derived for correlation between the alteration of simulation metrics with subjective improvements (p < 0.05), except with the AHI (p > 0.05). CONCLUSION Nasal surgery can decrease the total resistance of the upper airway and increase the nasal airflow volume and subjective sleep quality in patients with OSA and nasal obstruction. The altered airflow characteristics might contribute to the postoperative reduction of pharyngeal collapse in a subset of OSA patients.
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Affiliation(s)
- Lifeng Li
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China,
| | - Demin Han
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hongrui Zang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Nyall R London
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.,Sinonasal and Skull Base Tumor Program, National Institute on Deafness and Other Communication Disorders, NIH, Bethesda, Maryland, USA
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17
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Overview of Recent Advances in Surgical Treatments for OSA. CURRENT SLEEP MEDICINE REPORTS 2020. [DOI: 10.1007/s40675-020-00186-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Hismi A, Yu P, Locascio J, Levesque PA, Lindsay RW. The Impact of Nasal Obstruction and Functional Septorhinoplasty on Sleep Quality. Facial Plast Surg Aesthet Med 2020; 22:412-419. [PMID: 32429693 DOI: 10.1089/fpsam.2020.0005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Importance: Functional septorhinoplasty (FSRP) has been shown to improve both global and disease-specific quality of life (QOL). However, the mechanism by which FSRP improves QOL has not been fully defined. We reasoned that NAO may impact sleep quality and, therefore, studied the relationship using validated patient-reported outcome measures. Objective: To investigate the correlation between NAO and sleep quality using Nasal Obstruction Symptom Evaluation (NOSE) and Functional Outcomes of Sleep Quality (FOSQ-10) questionnaires, and to evaluate the effect of FSRP on NAO and sleep quality. Design, Setting, and Participants: This is a prospective longitudinal study of 125 patients undergoing FSRP for the repair of NAO between November 2017 and April 2019 in a university-based tertiary care medical center. The individuals (mean age = 38 ± 15.6 years, 65 females; 52%) were invited to complete the FOSQ-10 survey preoperatively and at 2, 4, 6, and 12 months postoperatively, and 122 of these patients also completed the NOSE questionnaire. Sixty individuals who reported a history of snoring also completed the Snoring Outcomes Survey (SOS). Twelve of 125 patients had obstructive sleep apnea. Patient demographics, nasal surgery, and medical histories and outcomes were analyzed. Intervention: Functional septorhinoplasty. Main Outcomes and Measures: Comparison of pre- and postoperative sleep and NAO scores to determine the correlation between the severity of NAO and sleep quality and the impact of correction of NAO on sleep quality. Results: A total of 125 patients completed FOSQ-10 questionnaire with a median score of 18.00 (IQR = 15.33-19.66) at baseline. Among these individuals, 122 patients completed the NOSE questionnaire with a median score of 65 (IQR = 45-75). A negative correlation between NOSE and FOSQ-10 scores was found at baseline (r = -0.380, p < 0.001). There was a significant difference in baseline FOSQ-10 scores between individuals with (n = 12, mean FOSQ-10 score = 13.28 ± 3.19) (p < 0.001) and without sleep apnea (n = 100, mean FOSQ-10 score = 17.24 ± 3.21). After FSRP, the NOSE and FOSQ-10 scores improved at each postoperative follow-up time point. The change in FOSQ-10 scores was statistically significant at months 2, 4, and 6 (p < 0.001) but not at month 12 (p = 0.161). The NOSE scores were statistically different from baseline level for each postoperative follow-up visits (p < 0.001-months 2, 4, and 6 and p = 0.031-month 12). The distribution of NOSE scores was not different statistically (p = 0.984). The negative correlation between NOSE and FOSQ-10 mean scores that was demonstrated at baseline increases postoperatively (r = 0.508, p < 0.001). Conclusions and Relevance: FSRP can improve both symptoms of NAO and sleep quality. The increased correlation between NAO and sleep quality after surgery is consistent with the hypothesis that improvement in NAO improves sleep quality and QOL.
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Affiliation(s)
- Anil Hismi
- Department of Otolaryngology, Massachussetts Eye and Ear, Boston, Massachussetts, USA.,Department of Otolaryngology, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Phoebe Yu
- Department of Otolaryngology, Massachussetts Eye and Ear, Boston, Massachussetts, USA
| | - Joseph Locascio
- Department of Neurology, Massachussetts General Hospital, Harvard Medical School, Boston, Massachussetts, USA
| | - Patricia A Levesque
- Department of Otolaryngology, Massachussetts Eye and Ear, Boston, Massachussetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachussetts, USA
| | - Robin Williams Lindsay
- Department of Otolaryngology, Massachussetts Eye and Ear, Boston, Massachussetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachussetts, USA
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19
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Abstract
Assessment of the nose is critical in evaluating obstructive sleep apnea (OSA) because the nose plays an important role in the physiology of sleep by regulating nasal airway resistance and stimulating ventilation. Nasal obstruction is common in sleep apnea, contributes to OSA, and interferes with tolerance of OSA treatment with continuous positive airway pressure (CPAP) or oral appliances. Medical treatment of nasal obstruction and rhinitis with nasal corticosteroid sprays is associated with improved OSA severity and sleep symptoms. Surgery for nasal obstruction, including septoplasty, turbinate reduction, rhinoplasty, and sinus surgery, improves OSA-related quality-of-life measures and CPAP tolerance.
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20
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Saadi R, Loloi J, Schaefer E, Lighthall JG. Outcomes of Cadaveric Allograft versus Autologous Cartilage Graft in Functional Septorhinoplasty. Otolaryngol Head Neck Surg 2019; 161:779-786. [PMID: 31385746 DOI: 10.1177/0194599819866812] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Our goal was to elucidate the efficacy and outcome profile of cadaveric allografts (homograft costal cartilage) in functional septorhinoplasty as compared with autografts (quadrangular cartilage, conchal cartilage, and autologous costal cartilage). STUDY DESIGN Retrospective chart review. SETTING Otolaryngology division of the Penn State Health Milton S. Hershey Medical Center. SUBJECTS AND METHODS A chart review of a single surgeon's practice was conducted with Current Procedural Terminology codes for septorhinoplasty (30410, 30420, 30430, 30435, 30450, 30465) from August 1, 2014, to August 1, 2017. All patients underwent functional septorhinoplasty for a chief complaint of nasal obstruction. Outcomes were collected up to 12 months following the operation and included the validated Nasal Obstruction Symptom Evaluation (NOSE), infection rate, malposition/warping of the graft, need for revision surgery, and graft loss. RESULTS A total of 171 cases were included in our data analysis. On multivariate analysis, there were no significant differences between patients who had autografts and those who had allografts in 3-, 6-, or 12-month postoperative NOSE score. Preoperative NOSE score was the only covariate to demonstrate a significant positive relationship to postoperative NOSE score. Regarding outcomes between autograft and allograft, no significant differences were found in rate of graft resorption (3.4% vs 5.6%, P = .680), graft warping (3.4% vs 0%, P = .309), infection (0% vs 1.9%, P = .316), or need for revision surgery (4.3% vs 5.6%, P = .709). CONCLUSION Autologous grafting is often the first choice in septorhinoplasty because of its presumed resistance to infection and resorption. Similar to autologous grafts, allografts are resistant to infection and resorption and demonstrate prolonged efficacy following functional septorhinoplasty.
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Affiliation(s)
- Robert Saadi
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Justin Loloi
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Eric Schaefer
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Jessyka G Lighthall
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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21
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Abstract
Obstructive sleep apnea (OSA) is a highly prevalent condition in the context of the global obesity epidemic with significant medical comorbidities and psychosocial implications. The first-line treatment of OSA is continuous positive airway pressure (CPAP). There is evidence to demonstrate an association between nasal obstruction and OSA. Therefore, medications and surgical interventions to address nasal obstruction may play a role in the treatment of OSA. In addition, surgical correction of nasal obstruction has been shown to improve CPAP tolerance and compliance.
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Affiliation(s)
- Mahmoud I Awad
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, 1305 York Avenue, 5th Floor, New York, NY 10021, USA
| | - Ashutosh Kacker
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, 1305 York Avenue, 5th Floor, New York, NY 10021, USA.
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22
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Functional Nasal Surgery and Use of CPAP in OSAS Patients: Our Experience. Indian J Otolaryngol Head Neck Surg 2018; 70:559-565. [PMID: 30464916 DOI: 10.1007/s12070-018-1396-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 05/07/2018] [Indexed: 10/14/2022] Open
Abstract
The surgical correction of nasal obstruction is definitely effective and recommended in patients with poor CPAP compliance, often secondary to the high pressures that need to be given in patients with nasal sub stenosis. For this reason, the objective of this study is the evaluation of the effectiveness and effects of the functional nose surgery on adherence to CPAP- therapy in patients (with moderate to severe OSAS with indication of ventilation therapy) poorly compliant with CPAP. The study was performed on a sample of 52 patients, 40 male and 12 female, aged between 29 and 72 years followed by the Otolaryngology Unit of the University Palermo in the period between January 2015 and January 2017. All patients were subjected to the following s iter: anamnesis with Epworth Sleepiness Scale, NOSE scale, evaluation of "CPAP usage data." Upper airway optical fiber endoscopy with Müller's maneuver. We performed various type of nasal surgery (septoplasty, decongestion of the lower turbinates and FESS) 6 months after the surgery, CPAP usage was evaluated and the NOSE scale has been reapplied. All patients had a subjective degree of obstruction classified in severe or extreme by the NOSE scale before surgery. Almost all patients reported a mild degree of obstruction after the surgery. About CPAP usage, the average usage has passed by 2, 3 h at night to 6, 8 h after the surgery. The result is significant because it shows how the nasal functional surgery can make selected patients suitable to ventilation therapy. As our work shows, a better nasal function allows to reduce the CPAP pressure, Therefore, we believe that all patients with medium to severe obstructive apnea syndrome and for whom night-time ventilation therapy (CPAP) is advised should be evaluated with endoscopy and anamnesis oriented to evaluate nasal obstructive pathologies that may reduce effectiveness of CPAP.
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23
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Huyett P, Soose RJ, Schell AE, Fernandez-Miranda JC, Gardner PA, Snyderman CH, Wang EW. Risk of Postoperative Complications in Patients with Obstructive Sleep Apnea following Skull Base Surgery. Otolaryngol Head Neck Surg 2018; 158:1140-1147. [DOI: 10.1177/0194599818771540] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives Obstructive sleep apnea (OSA) presents several challenges in skull base surgery, including increased intracranial pressure, worsened OSA with nasal packing, and avoidance of positive airway pressure (PAP) therapy postoperatively. The objective of this study was to examine the risk of postoperative complications in a skull base population with OSA in which PAP therapy is withheld. Study Design Retrospective cohort study. Setting Tertiary care hospital. Subjects and Methods Medical records of 414 adult patients undergoing anterior skull base procedures between January 1, 2014, and January 7, 2017, were retrospectively reviewed. Revision surgeries, skull base infections, sinus surgery, and orbital cases were excluded. Results Fifty-four (13.0%) patients with a diagnosis of OSA were identified. While the known patients with OSA were more likely to require postoperative supplemental oxygen (odds ratio [OR], 4.29; 95% confidence interval [CI], 2.38-7.75; P < .001), there was no increased risk of serious respiratory events or cerebrospinal fluid leak (CSF). To address the likely underdiagnosis of OSA in this cohort, subgroup analyses were performed of patients at high risk for OSA (body mass index >30 kg/m2 and hypertension) and demonstrated an increased risk of serious respiratory events (OR, 4.41; 95% CI, 1.24-15.7; P = .034) and CSF leak (13.6% vs 4.7%; P = .018). Conclusions Skull base patients with known OSA can be successfully managed with diligent care in the perioperative period when PAP therapy is withheld. However, OSA is likely underdiagnosed in the skull base population, and patients at high risk for undiagnosed OSA may be at the greatest risk for respiratory complications and CSF leak. Increased presurgical awareness and implementation of a perioperative management algorithm is needed.
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Affiliation(s)
- Phillip Huyett
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ryan J. Soose
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Amy E. Schell
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - Paul A. Gardner
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Carl H. Snyderman
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Eric W. Wang
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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24
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Scapuccin M, Schneider L, Rashid N, Zaghi S, Rosa T, Tsou YA, Liu S, Lazarini P, Capasso R, Ruoff C. Integrating the Divided Nasal Cannula Into Routine Polysomnography to Assess Nasal Cycle: Feasibility and Effect on Outcomes. J Clin Sleep Med 2018; 14:641-650. [PMID: 29609709 DOI: 10.5664/jcsm.7062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 01/09/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Patients suspected to have sleep-disordered breathing underwent an overnight polysomnography using a divided nasal cannula to gain additional information about the nasal cycle during sleep. METHODS This was a prospective, observational cohort study replacing the undivided nasal cannula with a divided nasal cannula during routine polysomnography (n = 28). RESULTS Integration of the divided nasal cannula pressure transducer system into routine polysomnography was easy and affordable. Most patients (89%) demonstrated nasal cycle changes during the test. Nasal cycle changes tended to occur during body position changes (62%) and transitions from non-rapid eye movement sleep to rapid eye movement sleep (41%). The mean nasal cycle duration was 2.5 ± 2.1 hours. Other sleep study metrics did not reveal statistically significant findings in relation to the nasal cycle. CONCLUSIONS Replacing an undivided nasal cannula with a divided nasal cannula is easy to implement, adding another physiologic measure to polysomnography. Although the divided nasal cannula did not significantly affect traditional polysomnographic metrics such as the apnea-hypopnea index or periodic limb movement index based on this small pilot study, we were able to replicate past nasal cycle findings that may be of interest to sleep clinicians and researchers. Given the ease with which the divided nasal cannula can be integrated, we encourage other sleep researchers to investigate the utility of using a divided nasal cannula during polysomnography.
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Affiliation(s)
- Marcelo Scapuccin
- Division of Sleep Surgery, Department of Otolaryngology - Head and Neck Surgery at Stanford University School of Medicine, Stanford, California.,Department of Otolaryngology - Head and Neck Surgery at Santa Casa School of Medicine, Santa Casa de Misericórida de São Paulo, São Paulo, SP, Brazil
| | - Logan Schneider
- Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, Stanford, California
| | - Nur Rashid
- Division of Sleep Surgery, Department of Otolaryngology - Head and Neck Surgery at Stanford University School of Medicine, Stanford, California.,Department of Otolaryngology - Head and Neck Surgery at University Putra Malaysia, Serdang, Selangor, Malaysia
| | - Soroush Zaghi
- Division of Sleep Surgery, Department of Otolaryngology - Head and Neck Surgery at Stanford University School of Medicine, Stanford, California
| | - Talita Rosa
- Division of Sleep Surgery, Department of Otolaryngology - Head and Neck Surgery at Stanford University School of Medicine, Stanford, California
| | - Yung-An Tsou
- Division of Sleep Surgery, Department of Otolaryngology - Head and Neck Surgery at Stanford University School of Medicine, Stanford, California.,Department of Otolaryngology, China Medical University Hospital, Taichung, Taiwan
| | - Stanley Liu
- Division of Sleep Surgery, Department of Otolaryngology - Head and Neck Surgery at Stanford University School of Medicine, Stanford, California
| | - Paulo Lazarini
- Department of Otolaryngology - Head and Neck Surgery at Santa Casa School of Medicine, Santa Casa de Misericórida de São Paulo, São Paulo, SP, Brazil
| | - Robson Capasso
- Division of Sleep Surgery, Department of Otolaryngology - Head and Neck Surgery at Stanford University School of Medicine, Stanford, California
| | - Chad Ruoff
- Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, Stanford, California
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25
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Ishii LE, Tollefson TT, Basura GJ, Rosenfeld RM, Abramson PJ, Chaiet SR, Davis KS, Doghramji K, Farrior EH, Finestone SA, Ishman SL, Murphy RX, Park JG, Setzen M, Strike DJ, Walsh SA, Warner JP, Nnacheta LC. Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty. Otolaryngol Head Neck Surg 2017; 156:S1-S30. [PMID: 28145823 DOI: 10.1177/0194599816683153] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective Rhinoplasty, a surgical procedure that alters the shape or appearance of the nose while preserving or enhancing the nasal airway, ranks among the most commonly performed cosmetic procedures in the United States, with >200,000 procedures reported in 2014. While it is difficult to calculate the exact economic burden incurred by rhinoplasty patients following surgery with or without complications, the average rhinoplasty procedure typically exceeds $4000. The costs incurred due to complications, infections, or revision surgery may include the cost of long-term antibiotics, hospitalization, or lost revenue from hours/days of missed work. The resultant psychological impact of rhinoplasty can also be significant. Furthermore, the health care burden from psychological pressures of nasal deformities/aesthetic shortcomings, surgical infections, surgical pain, side effects from antibiotics, and nasal packing materials must also be considered for these patients. Prior to this guideline, limited literature existed on standard care considerations for pre- and postsurgical management and for standard surgical practice to ensure optimal outcomes for patients undergoing rhinoplasty. The impetus for this guideline is to utilize current evidence-based medicine practices and data to build unanimity regarding the peri- and postoperative strategies to maximize patient safety and to optimize surgical results for patients. Purpose The primary purpose of this guideline is to provide evidence-based recommendations for clinicians who either perform rhinoplasty or are involved in the care of a rhinoplasty candidate, as well as to optimize patient care, promote effective diagnosis and therapy, and reduce harmful or unnecessary variations in care. The target audience is any clinician or individual, in any setting, involved in the management of these patients. The target patient population is all patients aged ≥15 years. The guideline is intended to focus on knowledge gaps, practice variations, and clinical concerns associated with this surgical procedure; it is not intended to be a comprehensive reference for improving nasal form and function after rhinoplasty. Recommendations in this guideline concerning education and counseling to the patient are also intended to include the caregiver if the patient is <18 years of age. Action Statements The Guideline Development Group made the following recommendations: (1) Clinicians should ask all patients seeking rhinoplasty about their motivations for surgery and their expectations for outcomes, should provide feedback on whether those expectations are a realistic goal of surgery, and should document this discussion in the medical record. (2) Clinicians should assess rhinoplasty candidates for comorbid conditions that could modify or contraindicate surgery, including obstructive sleep apnea, body dysmorphic disorder, bleeding disorders, or chronic use of topical vasoconstrictive intranasal drugs. (3) The surgeon, or the surgeon's designee, should evaluate the rhinoplasty candidate for nasal airway obstruction during the preoperative assessment. (4) The surgeon, or the surgeon's designee, should educate rhinoplasty candidates regarding what to expect after surgery, how surgery might affect the ability to breathe through the nose, potential complications of surgery, and the possible need for future nasal surgery. (5) The clinician, or the clinician's designee, should counsel rhinoplasty candidates with documented obstructive sleep apnea about the impact of surgery on nasal airway obstruction and how obstructive sleep apnea might affect perioperative management. (6) The surgeon, or the surgeon's designee, should educate rhinoplasty patients before surgery about strategies to manage discomfort after surgery. (7) Clinicians should document patients' satisfaction with their nasal appearance and with their nasal function at a minimum of 12 months after rhinoplasty. The Guideline Development Group made recommendations against certain actions: (1) When a surgeon, or the surgeon's designee, chooses to administer perioperative antibiotics for rhinoplasty, he or she should not routinely prescribe antibiotic therapy for a duration >24 hours after surgery. (2) Surgeons should not routinely place packing in the nasal cavity of rhinoplasty patients (with or without septoplasty) at the conclusion of surgery. The panel group made the following statement an option: (1) The surgeon, or the surgeon's designee, may administer perioperative systemic steroids to the rhinoplasty patient.
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Affiliation(s)
- Lisa E Ishii
- 1 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Travis T Tollefson
- 2 University of California Davis Medical Center, Sacramento, California, USA
| | - Gregory J Basura
- 3 University of Michigan Medical Center, Taubman Center, Ann Arbor, Michigan, USA
| | | | | | - Scott R Chaiet
- 6 The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kara S Davis
- 7 Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Karl Doghramji
- 8 Jefferson Sleep Disorder Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Edward H Farrior
- 9 Farrior Facial Plastic and Cosmetic Surgery, Tampa, Florida, USA
| | | | - Stacey L Ishman
- 11 Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Robert X Murphy
- 12 Lehigh Valley Health Network, Bethlehem, Pennsylvania, USA
| | - John G Park
- 13 Mayo Clinic Center for Sleep Medicine, Rochester, Minnesota, USA
| | - Michael Setzen
- 14 New York University School of Medicine, New York, New York, USA
| | - Deborah J Strike
- 15 Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Sandra A Walsh
- 10 Consumers United for Evidence-Based Healthcare, Fredericton, Canada
| | - Jeremy P Warner
- 16 Division Plastic and Reconstructive Surgery, Northshore University Health System, Northbrook, Illinois, USA
| | - Lorraine C Nnacheta
- 17 Department of Research and Quality, American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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26
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Fastenberg JH, Fang CH, Patel VM, Lin J, Stupak HD. The use of handheld nasal spirometry to predict the presence of obstructive sleep apnea. Sleep Breath 2017; 22:79-84. [DOI: 10.1007/s11325-017-1531-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 03/29/2017] [Accepted: 06/21/2017] [Indexed: 10/19/2022]
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27
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Sinonasal Characteristics in Patients with Obstructive Sleep Apnea Compared to Healthy Controls. Int J Otolaryngol 2017; 2017:1935284. [PMID: 28546812 PMCID: PMC5436061 DOI: 10.1155/2017/1935284] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 04/10/2017] [Indexed: 01/31/2023] Open
Abstract
Background. The difference in nasal obstruction between OSA patients and healthy individuals is not adequately documented. Our aim was to describe the sinonasal quality of life and nasal function in OSA patients and healthy controls using the sinonasal outcome test-20 (SNOT-20), nasal obstruction visual analog scale (NO-VAS), and peak nasal inspiratory flow (PNIF). Methodology and Principal. Ninety-three OSA patients and 92 controls were included in a case-control study from 2010 to 2015. Results. Mean SNOT-20 score in the OSA group was 1.69 (SD 0.84) compared to 0.55 (SD 0.69) in controls (p < 0.001, 95% CI [0.9, 1.4]). The mean NO-VAS score was 41.3 (SD 12.8) and 14.7 (SD 14.4) in the OSA group and controls, respectively, (p < 0.001, 95% CI [22.7, 30.6]). PNIF measured 105 litres/minute in the OSA group and 117 litres/minute in controls (p < 0.01, 95% CI [−21.8, −3.71]). There was a positive correlation between subjective nasal obstruction and change in PNIF after decongestion in the control group alone. Conclusions. OSA patients have a reduced sinonasal QoL and lower peak nasal inspiratory flow compared to controls. Treatment of nasal obstruction in OSA patients should be made a priority along with treatment of the ailment itself.
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Wu J, Zhao G, Li Y, Zang H, Wang T, Wang D, Han D. Apnea-hypopnea index decreased significantly after nasal surgery for obstructive sleep apnea: A meta-analysis. Medicine (Baltimore) 2017; 96:e6008. [PMID: 28151900 PMCID: PMC5293463 DOI: 10.1097/md.0000000000006008] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Nasal surgeries have been applied to obstructive sleep apnea (OSA) patients with nasal obstruction for decades. However, the efficiency of nasal surgery in improving OSA remains controversial.The aim of this study was to identify whether isolated nasal surgery can improve apnea-hypopnea index (AHI). METHODS Computerized searches were performed in MEDLINE, Web of Science, Cochrane Library, and Scopus from January 1, 2000 to April 30, 2016. A total of 18 articles and 587 participants were included. There were 1 randomized controlled trials, 2 nonrandomized trials, 11 prospective studies, and 4 retrospective studies. Data regarding study design (prospective/retrospective clinical trial, randomized, and controlled), population size, participant characteristics (age, gender, and body mass index), surgical intervention, and outcomes (AHI, Epworth sleep scale [ESS]) was collected. RESULTS Statistically significant improvement in AHI (subgroup 1: weighted mean difference [WMD] [95%confidence interval (CI)], -4.17 [-7.62, -0.73]; subgroup 2: WMD [95%CI], -4.19 [-7.51, -0.88]; overall: WMD [95%CI], -4.15 [-6.48, -1.82]) and ESS (subgroup 1: WMD [95%CI], -2.14 [-3.08, -1.19]; subgroup 2: WMD [95%CI], -4.70 [-5.95, -3.44]; overall: WMD [95%CI], -4.08 [-5.27, -2.88]) was revealed. CONCLUSION Both AHI and ESS improved significantly after isolated nasal surgery, but the improvement of AHI is slightly significant. Future randomized controlled trials are needed to confirm the long-term benefits of nasal surgery on OSA.
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29
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Ishii LE, Tollefson TT, Basura GJ, Rosenfeld RM, Abramson PJ, Chaiet SR, Davis KS, Doghramji K, Farrior EH, Finestone SA, Ishman SL, Murphy RX, Park JG, Setzen M, Strike DJ, Walsh SA, Warner JP, Nnacheta LC. Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty Executive Summary. Otolaryngol Head Neck Surg 2017; 156:205-219. [DOI: 10.1177/0194599816683156] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Lisa E. Ishii
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Gregory J. Basura
- University of Michigan Medical Center, Taubman Center, Ann Arbor, Michigan, USA
| | | | | | - Scott R. Chaiet
- The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kara S. Davis
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Karl Doghramji
- Jefferson Sleep Disorder Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Stacey L. Ishman
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - John G. Park
- Mayo Clinic Center for Sleep Medicine, Rochester, Minnesota, USA
| | - Michael Setzen
- New York University School of Medicine, New York, New York, USA
| | - Deborah J. Strike
- Department of Otolaryngology–Head and Neck Surgery, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Sandra A. Walsh
- Consumers United for Evidence-Based Healthcare, Fredericton, Canada
| | - Jeremy P. Warner
- Division Plastic and Reconstructive Surgery, Northshore University Health System, Northbrook, Illinois, USA
| | - Lorraine C. Nnacheta
- Department of Research and Quality, American Academy of Otolaryngology—Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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30
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Abstract
Obstructive sleep apnea is a common condition, primarily caused by narrowing of the nasal and pharyngeal airway. Treatment with continuous positive airway pressure (CPAP) is considered the first line of therapy, but long-term compliance is only about 40%, often because of nasal obstruction. Any nasal obstruction can worsen CPAP compliance. Treatment of the nasal obstruction with topical nasal steroid sprays or nasal dilators has been shown to improve sleep disordered breathing. Surgical treatment of nasal obstruction, has been shown to improve sleep disordered breathing, as well as CPAP requirement and compliance with CPAP.
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Affiliation(s)
- Samuel A Mickelson
- Advanced Ear Nose & Throat Associates, The Atlanta Snoring & Sleep Disorders Institute, 960 Johnson Ferry Road Northeast, Suite 200, Atlanta, GA 30342, USA.
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Bonzelaar LB, Salapatas AM, Hwang MS, Andrews CC, Price NY, Friedman M. The effect of oral positioning on the hypopharyngeal airway. Laryngoscope 2016; 127:1471-1475. [DOI: 10.1002/lary.26321] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 07/18/2016] [Accepted: 08/19/2016] [Indexed: 11/10/2022]
Affiliation(s)
| | - Anna M. Salapatas
- Chicago ENT: Advanced Center for Specialty Care; Chicago Illinois U.S.A
| | - Michelle S. Hwang
- Chicago ENT: Advanced Center for Specialty Care; Chicago Illinois U.S.A
| | | | - Naftali Y. Price
- Chicago ENT: Advanced Center for Specialty Care; Chicago Illinois U.S.A
| | - Michael Friedman
- Rush University Medical Center; Chicago Illinois U.S.A
- Chicago ENT: Advanced Center for Specialty Care; Chicago Illinois U.S.A
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Abstract
BACKGROUND The purpose of this study was to determine whether functional rhinoplasty alone results in a significant improvement in obstructive sleep apnea parameters in patients with nasal obstruction. METHODS Records of consecutive adult patients with nasal obstruction who underwent surgery to repair their nasal inlet and completed preoperative and postoperative polysomnography were reviewed. Patients underwent polysomnography before and after functional septorhinoplasty. Long-term follow-up using Nasal Obstruction Symptom Evaluation scores was conducted. Statistical analysis was performed using the Wilcoxon signed rank sum test. A Holm-Bonferroni sequential correction was also used because of multiple statistical comparisons being made. RESULTS Twenty-six patients were included in this study. Mean apnea-hypopnea index scores preoperatively was 24.7, which dropped to a mean postoperative apnea-hypopnea index of 16, a reduction of 35 percent (p = 0.013). Excluding patients with a body mass index greater than 30 resulted in improved apnea-hypopnea index scores, from 22.5 to 9.6, a mean 57 percent reduction (p < 0.01). CONCLUSIONS Functional rhinoplasty may have the potential to significantly improve the severity of obstructive sleep apnea for select patients with nasal obstruction. The nasal airflow improvement may modify pharyngeal aerodynamics. This is a fast and minimally invasive approach to consider in patients with obstructive sleep apnea and nasal obstruction, especially in patients with a body mass index less than 30. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Effects of nasal continuous positive airway pressure therapy on partners' sexual lives. Eur Arch Otorhinolaryngol 2015; 273:133-7. [PMID: 25876002 DOI: 10.1007/s00405-015-3546-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 02/03/2015] [Indexed: 10/24/2022]
Abstract
To assess sexual functioning in male and female partners before and after nasal continuous positive airway pressure (CPAP) therapy in men with obstructive sleep apnea (OSA). Twenty-one male patients with moderate to severe OSA and erectile dysfunction, and their female partner, were recruited into this prospective study. Males diagnosed with OSA were treated with nasal CPAP therapy for 12 weeks. Women were assessed for sexual functioning using the Female Sexual Function Index (FSFI), and for mood status using the Beck Depression Inventory (BDI), before and after their male partner underwent nasal CPAP therapy. Sexual functioning was assessed in men using the International Index of Erectile Function (IIEF), before and after nasal CPAP therapy. After nasal CPAP therapy for OSA in men, IIEF scores were significantly higher than pre-treatment scores. Total pre- and post-treatment IIEF scores (mean ± standard deviation) were 50.28 ± 15.88 and 65.42 ± 7.47, respectively, P < 0.01. Pre- and post-treatment FSFI scores in women were 21.54 ± 6.62 and 29.94 ± 3.76, respectively, P < 0.01. Pre- and post-treatment BDI scores in women were 14.61 ± 9.69 and 12.42 ± 8.92, respectively, P < 0.01. Following treatment of men with OSA, our data indicate benefits for nasal CPAP therapy on sexual functioning in both the male and female partners. Moreover, our findings indicate that improved sexual function in women after their male partner underwent nasal CPAP also had psychological benefits.
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Risk factors of emergence agitation in adults undergoing general anesthesia for nasal surgery. Clin Exp Otorhinolaryngol 2015; 8:46-51. [PMID: 25729495 PMCID: PMC4338091 DOI: 10.3342/ceo.2015.8.1.46] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 02/09/2014] [Accepted: 02/10/2014] [Indexed: 01/08/2023] Open
Abstract
Objectives To identify the incidence and the risk factors of emergence agitation in adults undergoing general anesthesia for nasal surgery. Methods We retrospectively examined 792 patients aged ≥18 years who underwent general anesthesia for elective nasal surgery between July 2012 and August 2013. Patients in the postanesthesia care unit with a Richmond Agitation Sedation Scale≥+1 at any time were considered to have emergence agitation. Results The overall incidence of emergence agitation is 22.2%. From multivariate regression analysis, the following six variables were found to be significantly associated with emergence agitation (P<0.05): younger age, recent smoking, sevoflurane anesthesia, postoperative pain on the numerical rating scale (NRS)≥5, presence of a tracheal tube, and presence of a urinary catheter. Presence of a tracheal tube was the greatest risk factor, increasing the risk of developing emergence agitation by approximately fivefold (odds ratio, 5.448; 95% confidence interval, 2.973 to 9.982). Younger age was also a strong risk factor (odds ratio, 0.975 for each 1-year increase; 95% confidence interval, 0.964 to 0.987). Current smoking, sevoflurane anesthesia, postoperative pain of NRS≥5, and the presence of a urinary catheter nearly doubled the risk of emergence agitation. Conclusion Emergence agitation following general anesthesia is a common complication in adult nasal surgery patients. To reduce the occurrence and consequences of agitation episodes, elimination of the associated risk factors is necessary, especially in at-risk patients.
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Importance of yawning in the evaluation of excessive daytime sleepiness: a prospective clinical study. Eur Arch Otorhinolaryngol 2014; 272:3611-5. [PMID: 25261103 DOI: 10.1007/s00405-014-3302-1] [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: 06/12/2014] [Accepted: 09/19/2014] [Indexed: 10/24/2022]
Abstract
As a dark and not fully understood side of human nature, yawning is believed to be a signs of various physiological or pathological behaviors of human. In this study, we aimed to investigate the importance of yawning in the evaluation of sleepiness. One hundred and twenty-nine snorers who were suspected to have obstructive sleep apnea syndrome underwent polysomnography and were asked to fill the Epworth sleepiness scale. The number of yawnings of patients was counted during the day following polysomnography. Patients were stratified into two groups: those have apnea hypopnea index <5 (n = 43, group 1) and those have apnea hypopnea index >30 (n = 86, group 2). Mean duration of sleep phases, oxygen saturations, sleep efficacies, yawning frequencies and Epworth scores of the groups were compared. Correlations of yawning frequency with Epworth scores, duration of sleep phases and mean oxygen saturations were investigated. Sleep efficacies were similar between the groups (p > 0.05). Yawning frequencies in group 1 and group 2 were 43.48 and 75.76 (mean rank), respectively (p < 0.01). Mean N1, N2, N3 phase durations and oxygen saturations were significantly lower in group 2 (p < 0.01). While there was a negative correlation between yawning frequency and duration of the non-REM phases and mean oxygen saturation (r = -0.53 and r = -0.31, respectively, p < 0.05), yawning frequency was positively correlated with Epworth scores (r = 0.46, p < 0.05). In addition to the shortened phases of sleep, increased Epworth score and decreased oxygen saturation, increased yawning frequency may indicate sleep deprivation.
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Yalamanchali S, Cipta S, Waxman J, Pott T, Joseph N, Friedman M. Effects of Endoscopic Sinus Surgery and Nasal Surgery in Patients with Obstructive Sleep Apnea. Otolaryngol Head Neck Surg 2014; 151:171-5. [PMID: 24687940 DOI: 10.1177/0194599814528296] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 02/26/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate the impact of combined nasal surgery and endoscopic sinus surgery on the objective measurements of obstructive sleep apnea (OSA) and sleep architecture by comparing polysomnographic data before and after combined surgery in patients with OSA. STUDY DESIGN Case series with chart review. SETTING A single clinical site. SUBJECTS AND METHODS Patients with OSA and chronic rhinosinusitis who underwent combined nasal surgery and endoscopic sinus surgery and preoperative and postoperative polysomnography were identified. Patient charts were reviewed and preoperative and postoperative body mass index, apnea-hypopnea index (AHI), mean and minimum oxygen saturation, sleep efficiency, and sleep staging were compared. RESULTS Fifty-six patients were included in our study. Patients were divided into 3 groups on the basis of the severity of OSA: those with mild OSA (n = 9), those with moderate OSA (n = 23), and those with severe OSA (n = 24). After combined nasal and sinus surgery, the mean AHI significantly decreased from 33.5 ± 22.0 to 29.4 ± 20.8 (P = .009) in our overall population. Specifically, AHI improved significantly in patients with moderate OSA (from 22.3 ± 4.8 to 20.7 ± 8.2, P = .023) and severe OSA (from 52.3 ± 21.4 to 43.6 ± 23.9, P = .034), while patients with mild OSA did not have significant changes in AHI. Successful surgical procedures were achieved in only 2 of 56 patients. CONCLUSION Although combined nasal and sinus surgery may slightly improve AHI in a certain group of patients, it does not cure OSA or have a significant clinical impact.
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Affiliation(s)
- Sreeya Yalamanchali
- Chicago ENT Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Stephanie Cipta
- Chicago ENT Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Jonathan Waxman
- Chicago ENT Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Thomas Pott
- Chicago ENT Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Ninos Joseph
- Chicago ENT Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Michael Friedman
- Chicago ENT Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA Rush University Medical Center, Chicago, Illinois, USA
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Abstract
BACKGROUND Sleep-disordered breathing (SDB) is a spectrum of airway collapse, ranging from primary snoring to profound obstructive sleep apnea (OSA). Studies have shown an association between impaired nasal breathing and SDB; consequently, treatments of nasal obstruction are often used in an attempt to improve disease severity. The authors performed a review of the literature to determine the impact of nasal obstruction and the effectiveness of nonsurgical and surgical interventions on SDB. METHODS Relevant literature up to 2012 on the association between nasal obstruction and SDB and effectiveness of nonsurgical and surgical treatment of the nose in SDB were reviewed. RESULTS The literature is mostly limited to uncontrolled case series in which patient groups, interventions, disease definitions, and outcome measures are not standardized. Nasal medications, including intranasal steroids and nasal decongestants, have not been shown to improve either snoring or OSA. Nasal dilators have no impact on OSA but may improve snoring. Surgery for nasal obstruction does not improve objective indicators of SDB but can improve subjective elements of disease, such as snoring, sleepiness, and quality of life. Nasal surgery can facilitate continuous positive airway pressure use in cases where nasal obstruction is the factor limiting compliance. CONCLUSION Nasal obstruction plays a modulating, but not causative, role in SDB. Nasal interventions may improve subjective aspects of snoring and OSA but do not improve objective indicators of disease. Standardization of methods and higher evidence level studies will further clarify the benefit of nasal interventions in the treatment of SDB.
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Affiliation(s)
- Eric K Meen
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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Leitzen KP, Brietzke SE, Lindsay RW. Correlation between nasal anatomy and objective obstructive sleep apnea severity. Otolaryngol Head Neck Surg 2013; 150:325-31. [PMID: 24334963 DOI: 10.1177/0194599813515838] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine if a correlation exists between nasal anatomical obstruction and obstructive sleep apnea severity as measured by overnight polysomnogram (PSG). STUDY DESIGN Cross-sectional study. SETTING Tertiary medical center. SUBJECTS AND METHODS Subjects were recruited immediately prior to an overnight, in-lab PSG. All subjects who agreed to participate underwent a standardized nasal examination performed by the senior author and then completed the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire, the Snore Outcomes Survey (SOS), and the Epworth Sleepiness Scale (ESS) prior to their sleep study. In addition, tonsil size, Mallampati score, Friedman tongue position, neck circumference, uvula length, and occlusion were assessed and documented. Nasal anatomy assessments were then compared with PSG, NOSE, SOS, and ESS results. Bonferroni correction was used to account for multiple comparisons. RESULTS One hundred subjects were included in the study. Fifty-nine subjects (59%) were found to have obstructive sleep apnea syndrome (OSAS) (mean apnea-hypopnea index, 13.1; range, 0-64). Severity of OSAS was associated with age (Spearman's ρ = 0.386, P = .0001). No single nasal anatomy measurement or combined nasal anatomy index was found to correlate with objective sleep-disordered breathing severity measured by PSG. The sample size should have provided 90% power to detect a significant correlation if one existed. After accounting for multiple comparisons, turbinate hypertrophy was found to correlate with the NOSE score (0.3577, P = .0305 corrected), and external and internal nasal valve collapse correlated with each other (0.4986, P < .0001 corrected). CONCLUSIONS Objectively assessed abnormal nasal anatomy was not found to be significantly correlated with PSG-measured OSAS severity. Specific objective measurements of obstructive nasal anatomy were correlated to subjective measures of nasal obstruction.
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Affiliation(s)
- Keith P Leitzen
- Department of Otolaryngology/Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
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Correa LP. Overview of Oral Appliance Therapy for the Management of Obstructive Sleep Apnea. Sleep Med Clin 2013. [DOI: 10.1016/j.jsmc.2013.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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