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Yang HC, Umugire A, Song MK, Man SC, Kim HC, Kim J, Vena D, Huyett P, Choi I, Wellman AD. Sleep apnea patients with epiglottic collapse elevate their larynx more with swallowing; videofluoroscopic swallowing study of 80 patients. Sleep Breath 2024:10.1007/s11325-024-03065-6. [PMID: 38795279 DOI: 10.1007/s11325-024-03065-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/26/2024] [Accepted: 05/20/2024] [Indexed: 05/27/2024]
Abstract
OBJECTIVE The epiglottis plays an integral role in the swallowing mechanism and is also implicated as an obstruction site in obstructive sleep apnea (OSA). The underlying causes of epiglottic collapse during sleep remain unclear. This study aimed to investigate the cognitive functions using the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) and the neurophysiological and anatomical factors using videofluoroscopic swallowing studies (VFSS). We compared patients with OSA exhibiting epiglottic collapse to those without, assessing differences in anatomical or neurophysiological characteristics. METHODS The study included 12 patients with epiglottic collapse (Epi-group) and 68 without (non-Epi group), all undergoing overnight polysomnography (PSG), drug-induced sleep endoscopy (DISE), LOTCA, and VFSS. Oral transit time (OTT), pharyngeal delay time (PDT), and pharyngeal transit time (PTT) were considered as neurophysiological traits, and laryngeal elevation length (LE) as anatomical trait, and were measured across various test diets (10 ml of liquid, soft, or solid). RESULTS The study comprised 80 individuals, 57 men and 23 women, with no significant age, sex, body mass index or PSG parameters between groups, or DISE findings, with the exception of epiglottic collapse. Swallowing metrics from VFSS were normal, with no differences in OTT, PDT, PTT, or LOTCA scores. Notably, patients with epiglottic collapse showed a greater laryngeal elevation when swallowing soft and solid foods (p = 0.025 and p = 0.048, respectively). CONCLUSIONS Patients with epiglottic collapse do not exhibit neurophysiological or cognitive impairments when compared to non-Epi group. However, the Epi-group displayed a significantly increased laryngeal elevation length. This suggests that anatomical factors may have a more substantial role in the development of epiglottic collapse than neurophysiological factors.
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Affiliation(s)
- Hyung Chae Yang
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Alphonse Umugire
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Min-Keun Song
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School and Hospital, 42 Jebong-ro Dong-gu, Gwangju, 61479, South Korea.
| | - Sung Chung Man
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Hong Chan Kim
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Jisun Kim
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Daniel Vena
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Phillip Huyett
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA
| | - Insung Choi
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School and Hospital, 42 Jebong-ro Dong-gu, Gwangju, 61479, South Korea.
| | - Andrew D Wellman
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Cagna DR, Donovan TE, McKee JR, Eichmiller F, Metz JE, Marzola R, Murphy KG, Troeltzsch M. Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 2023; 130:453-532. [PMID: 37453884 DOI: 10.1016/j.prosdent.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 07/18/2023]
Abstract
The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of the 2022 dental literature to briefly touch on several topics of interest to modern restorative dentistry. Each committee member brings discipline-specific expertise in their subject areas that include (in order of the appearance in this report): prosthodontics; periodontics, alveolar bone, and peri-implant tissues; dental materials and therapeutics; occlusion and temporomandibular disorders; sleep-related breathing disorders; oral medicine and oral and maxillofacial surgery; and dental caries and cariology. The authors focused their efforts on reporting information likely to influence the daily dental treatment decisions of the reader with an emphasis on innovations, new materials and processes, and future trends in dentistry. With the tremendous volume of literature published daily in dentistry and related disciplines, this review cannot be comprehensive. Instead, its purpose is to update interested readers and provide valuable resource material for those willing to subsequently pursue greater detail on their own. Our intent remains to assist colleagues in navigating the tremendous volume of newly minted information produced annually. Finally, we hope that readers find this work helpful in managing patients.
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Affiliation(s)
- David R Cagna
- Professor, Associate Dean, Chair, and Residency Director, Department of Prosthodontics, University of Tennessee Health Sciences Center College of Dentistry, Memphis, Tenn.
| | - Terence E Donovan
- Professor, Department of Comprehensive Oral Health, University of North Carolina School of Dentistry, Chapel Hill, NC
| | - James R McKee
- Private practice, Restorative Dentistry, Downers Grove, Ill
| | - Frederick Eichmiller
- Vice President and Science Officer (Emeritus), Delta Dental of Wisconsin, Stevens Point, Wis
| | - James E Metz
- Private practice, Restorative Dentistry, Columbus, Ohio
| | | | - Kevin G Murphy
- Associate Clinical Professor, Department of Periodontics, University of Maryland College of Dentistry, Baltimore, Md
| | - Matthias Troeltzsch
- Private practice, Oral, Maxillofacial, and Facial Plastic Surgery, Ansbach, Germany; Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig Maximilian University of Munich (LMU), Munich, Germany
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Van de Perck E, Kazemeini E, Van den Bossche K, Willemen M, Verbraecken J, Vanderveken OM, Op de Beeck S. The effect of CPAP on the upper airway and ventilatory flow in patients with obstructive sleep apnea. Respir Res 2023; 24:143. [PMID: 37259138 DOI: 10.1186/s12931-023-02452-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/14/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) is the mainstay of treatment for obstructive sleep apnea (OSA). However, data about its effect on the upper airway, especially the epiglottis, are scarce. The aim of this study was to investigate the changes in upper airway dimensions and inspiratory flow in response to incremental pressure levels. METHODS This is a secondary analysis of a prospective clinical trial in which patients with moderate to severe OSA underwent drug-induced sleep endoscopy with simultaneous recordings of flow and mask pressure. CPAP was titrated in small increments. For each pressure level a representative 3-breath segment was selected to determine specific flow features. The corresponding endoscopic footage was reviewed to assess the degree of upper airway collapse in a semi-quantitative manner. RESULTS A total of 214 breath segments were obtained from 13 participants (median [Q1-Q3]; apnea-hypopnea index, 24.9 [20.1-43.9] events/h; body mass index 28.1 [25.1-31.7] kg/m²). CPAP significantly increased cross-sectional dimensions of the soft palate, lateral walls and tongue base, but not of the epiglottis, and induced epiglottis collapse in one subject. Increased pressure improved peak inspiratory flow and median ventilation in all patients, even in the presence of persistent epiglottis collapse. CONCLUSION CPAP does not effectively address epiglottis collapse in patients with OSA. However, it normalizes inspiratory flow regardless of its effect on the epiglottis. This clinical trial was registered on January 18th, 2020 on ClinicalTrials.gov with identifier NCT04232410.
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Affiliation(s)
- Eli Van de Perck
- Faculty of Medicine and Health Sciences, Department of Translational Neurosciences, University of Antwerp, Universiteitsplein 1 - D.T.494, Wilrijk, Belgium.
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.
| | - Elahe Kazemeini
- Faculty of Medicine and Health Sciences, Department of Translational Neurosciences, University of Antwerp, Universiteitsplein 1 - D.T.494, Wilrijk, Belgium
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Karlien Van den Bossche
- Faculty of Medicine and Health Sciences, Department of Translational Neurosciences, University of Antwerp, Universiteitsplein 1 - D.T.494, Wilrijk, Belgium
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Marc Willemen
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium
| | - Johan Verbraecken
- Faculty of Medicine and Health Sciences, Department of Translational Neurosciences, University of Antwerp, Universiteitsplein 1 - D.T.494, Wilrijk, Belgium
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium
- Department of Pulmonology, Antwerp University Hospital, Edegem, Belgium
| | - Olivier M Vanderveken
- Faculty of Medicine and Health Sciences, Department of Translational Neurosciences, University of Antwerp, Universiteitsplein 1 - D.T.494, Wilrijk, Belgium
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium
| | - Sara Op de Beeck
- Faculty of Medicine and Health Sciences, Department of Translational Neurosciences, University of Antwerp, Universiteitsplein 1 - D.T.494, Wilrijk, Belgium
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium
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Surgical Treatment Options for Epiglottic Collapse in Adult Obstructive Sleep Apnoea: A Systematic Review. LIFE (BASEL, SWITZERLAND) 2022; 12:life12111845. [PMID: 36430980 PMCID: PMC9698204 DOI: 10.3390/life12111845] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/06/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022]
Abstract
The critical role of epiglottis in airway narrowing contributing to obstructive sleep apnoea (OSA) and continuous positive airway pressure (CPAP) intolerance has recently been revealed. This systematic review was conducted to evaluate available surgical treatment options for epiglottic collapse in adult patients with OSA. The Pubmed and Scopus databases were searched for relevant articles up to and including March 2022 and sixteen studies were selected. Overall, six different surgical techniques were described, including partial epiglottectomy, epiglottis stiffening operation, glossoepiglottopexy, supraglottoplasty, transoral robotic surgery, maxillomandibular advancement and hypoglossal nerve stimulation. All surgical methods were reported to be safe and effective in managing selected OSA patients with airway narrowing at the level of epiglottis. The surgical management of epiglottic collapse can improve OSA severity or even cure OSA, but can also improve CPAP compliance. The selection of the appropriate surgical technique should be part of an individualised, patient-specific therapeutic approach. However, there are not enough data to make definitive conclusions and additional high-quality studies are required.
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