SLEEP-GOAL: A multicenter success criteria outcome study on 302 obstructive sleep apnoea (OSA) patients

OBJECTIVE

To demonstrate SLEEP-GOAL as a more holistic and comprehensive success criterion for Obstructive Sleep Apnoea (OSA) treatment.

METHODS

A prospective 7-country clinical trial of 302 OSA patients, who met the selection criteria, and underwent nose, palate and/or tongue surgery. Pre- and post-operative data were recorded and analysed based on both the Sher criteria (apnoea hypopnea index, AHI reduction 50% and <20) and the SLEEP-GOAL.

RESULTS

There were 229 males and 73 females, mean age of 42.4±17.3 years, mean BMI 27.9±4.2. The mean VAS score improved from 7.7±1.4 to 2.5±1.7 (p<0.05), mean Epworth score (ESS) improved from 12.2±4.6 to 4.9±2.8 (p<0.05), mean body mass index (BMI) decreased from 27.9±4.2 to 26.1±3.7 (p>0.05), gross weight decreased from 81.9±14.3kg to 76.6±13.3kg. The mean AHI decreased 33.4±18.9 to 14.6±11.0 (p<0.05), mean lowest oxygen saturation (LSAT) improved 79.4±9.2% to 86.9±5.9% (p<0.05), and mean duration of oxygen <90% decreased from 32.6±8.9 minutes to 7.3±2.1 minutes (p<0.05). The overall success rate (302 patients) based on the Sher criteria was 66.2%. Crosstabulation of respective major/minor criteria fulfilment, based on fulfilment of two major and two minor or better, the success rate (based on SLEEP-GOAL) was 69.8%. Based solely on the Sher criteria, 63 patients who had significant blood pressure reduction, 29 patients who had BMI reduction and 66 patients who had clinically significant decrease in duration of oxygen <90% would have been misclassified as "failures".

CONCLUSION

AHI as a single parameter is unreliable. Assessing true success outcomes of OSA treatment, requires comprehensive and holistic parameters, reflecting true end-organ injury/function; the SLEEP-GOAL meets these requirements.

Minimally invasive surgery under local anaesthesia for chronic rhinosinusitis with nasal polyps: our experience in older adults

OBJECTIVE

This paper aims to report our experience with a minimally invasive surgical procedure for the treatment of chronic rhinosinusitis with nasal polyps, performed in a day-surgery setting under local anaesthesia.

METHODS

A retrospective study of 30 patients with chronic rhinosinusitis with nasal polyps was conducted. Sino-Nasal Outcome Test 22 and modified Lund-Kennedy scores were collected. Intra- and post-operative pain was evaluated using a 10-point visual analogue scale.

RESULTS

The mean Sino-Nasal Outcome Test 22 score decreased from 41.8 ± 15.8 pre-operatively to 13.3 ± 9.5 post-operatively (p < 0.001). Accordingly, the mean endoscopic score decreased from 6.8 ± 1.8 to 0.2 ± 0.7 (p < 0.001). The mean intra-operative pain score was 2.9 ± 3.2, and 29 patients (96.7 per cent) reported no pain in the post-operative period (visual analogue scale score = 0).

CONCLUSION

Our study confirms that minimally invasive surgery represents a safe, repeatable procedure that results in remarkable subjective and objective improvement, without intra- and post-operative pain or discomfort.

[Surgery for obstructive sleep apnea]

Nasal continuous positive airway pressure (CPAP) is considered an ideal treatment for treating Obstructive Sleep Apnea Syndrome (OSAS), due to its being conservative and reversible; however, there is a poor rate of adherence in its long-term use. Surgery can significantly complement those cases where CPAP is not tolerated. Surgery for OSAS must be carried out taking into account the degree of obstructive apnea, the place of greatest obstruction and the experience of the medical team. The more severe the OSAS, the more aggressive the surgical therapy can be. The place of obstruction must not be considered in a simplistic way, in which only one place of obstruction is defined, but as a general alteration of the airway where the surgeon must act in order to carry out an effective remodelling. This paper describes different types of surgery and their efficacy in OSAS according to the anatomical area involved (nose, adenoidal surgery, tonsils, soft palate, base of the tongue, hypopharynx and bimaxillary protrusion). The scientific evidence shows that at present reconstructive surgery of the airway competes effectively with medical treatment.

Cognitive performance in Rett syndrome girls: a pilot study using eyetracking technology

BACKGROUND

Rett syndrome (RS) is a pervasive developmental disorder with cognitive and neuromotor impairments (including loss of handiness and loss of communicative skills).

OBJECTIVE

To verify whether girls with RS use their gaze intentionally, by observing their performance in three cognitive tasks: (1) verbal instruction condition (look at picture X), (2) recognition and matching of pictures (look at the one that is the same), and (3) categorization of pictures (look at the one that is similar).

METHOD

Seven girls diagnosed with RS according to DSM-IV criteria were studied. Eyegaze technology was used to record the girls' eye movements' responses to visual stimulation.

RESULTS

The comparison of fixation time on the alternatives revealed a higher percentage (62.4%) of correct alternatives (chi(2) = 76.31; P = 0.000). Of the seven children assessed, only one did not present predominance of fixations on the correct alternatives in any one of the tasks. One did well in all tasks. Six responded correctly to all verbal instructions.

CONCLUSION

The rate of correct answers suggests that there is measurable and intentional gaze in RS girls and it can be used as a path to explore their cognitive performance.

Pleomorphic adenoma of the epiglottis

Pleomorphic adenoma is the most common benign tumor of the major salivary glands. A pleomorphic adenoma in the larynx constitutes a rarity. A small number of cases have been reported in the literature. We report on a case seen in our hospital, and have reviewed those cases published in the medical literature during the last 25 years.