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Oropharyngeal level showing a key hole airway collapse in subject number 12, (A) during Muller’s maneuver and (B) during induced sleep nasoendoscopy. Notice: the increase in the degree of lateral pharyngeal wall collapse in (B).
Source publication
Background: Identifying the site of obstruction and the pattern of airway change during sleep are the key points essential to guide surgical treatment decision making for snoring and obstructive sleep apnoea–hypopnoea syndrome (OSAHS) in adults. The use of nasopharyngoscopy during the application of the Müller maneuver is frequently employed to est...
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The aim of this study was to investigate the predictive value of snoring frequency in the diagnosis and severity of obstructive sleep apnea.
Citations
... However, there was no significant difference between the results of Muller's maneuver (sitting and supine positions) and DISE as regards the shape of collapse. In the Ibrahim et al. study [26], they found that DISE was more precise than the Muller maneuver in judging the obstruction shape at the retro-palatal and the retro-glossal level, while it was similar the Muller maneuver in evaluating the obstruction degree at retropalatal, retro-glossal, and hypopharyngeal levels. ...
Background
Pre-operative imaging tools play a crucial role in the anatomic assessment of the upper airway and adjacent structures in obstructive sleep apnea patients. The current study was aimed at comparing and correlating the results of videofluoroscopy in evaluating upper airway obstruction in surgically fit obstructive sleep apnea “OSA” patients with fiberoptic nasoendoscopic examination during the awake “Muller’s maneuver” and during sleep induced with propofol for better selection of the suitable surgical maneuver. The present study was an observational cross-sectional study of 69 surgically fit OSA patients (36 males and 33 females); their ages ranged between 29 and 65 years with mean age of 45.87 ± 9.68 years. The patients were selected from otorhinolaryngology, phoniatric, and pulmonology outpatient clinics during the period from February 2019 to January 2020.
Results
The present study demonstrated that no statistically significant difference was found between the three techniques (video-fluoroscopy, awake fiber-optic nasoendoscopy, and drug-induced sleep nasoendoscopy “DISE”) as regards the shape of upper airway collapse at retropalatal, retroglossal, and hypopharyngeal levels in OSA patient ( P : 0.621, 0.669, and 1.0 respectively). Statistically, a significant difference was observed between video-fluoroscopy, awake fiber-optic nasoendoscopy on one hand, and DISE on the other one regarding the grade of upper airway collapse at all levels ( P : 0.006, 0.037, and 0.003). It was a mild significant difference in favor of DISE.
Conclusion
Video-fluoroscopy is a good, reliable complementary preoperative assessment tool to identify obstruction patterns of the upper airway in OSA patients with quantitative measurements.
... Sürekli pozitif hava basıncı tedavisi uyku apnesi hastalığının tedavi ve komplikasyonlarının önlenmesinde en etkili tedavi biçimidir (5). Uyku apnesi hastalığının şiddetini belirlemek için sıklıkla polisomnografik parametrelerden apne-hipopne indeksi (AHİ) kullanılır (6). OUAS toplumun büyük bir kısmını etkileyen ciddi bir sağlık sorunudur bu sebepten ötürü etkin bir tedavi yapabilmek bir gereklilik halini almıştır. ...
Aim:Obstructive Sleep Apnea syndrome (OSAS) is an important health issue characterized by repetitive episodes of upper airway obstruction affecting many different systems in the human body. In this study, we aimed to examine the relationship of daytime sleepiness with quality of life in patients with OSAS.Methods:In this study, adult patients, who underwent diagnostic polysomnography for the first time in our clinic, were included. Data on physical examination findings and demographic characteristics were recorded. The Epworth Sleepiness Scale, 36-Item Short Form Health Survey (SF-36), Beck Anxiety Inventory, and the Beck Depression Inventory were administered to the patients.Results:A total of 136 patients with the mean age of 45.5±9.7 (22- 68) were included in the study. Thirty four patients were (25%) female and 102 were male (75%). Simple snoring was detected in 30 patients (22.1%), mild OSAS in 24 patients (17.6%), moderate OSAS in 26 patients (19.1%) and severe OSAS was found in 56 patients (42.1%). Epworth Sleepiness Scale scores in patients with severe OSAS were statistically significantly higher than in other patients. The lowest SF-36 scores were observed in severe OSAS patients.Conclusion:The quality of life was significantly decreased in patients with severe OSAS. We assume that quality life was negatively correlated Epworth Sleepiness Scale scores.
Background
Robin sequence (RS) describes a heterogeneous population with micrognathia, glossoptosis, and upper airway obstruction (UAO). Workup, treatment, outcomes assessment, and research inclusion are widely variable. Despite several classifications and algorithms, none is broadly endorsed. The objective of this investigation was to develop and trial a novel classification system designed to enhance clinical communication, treatment planning, prognostication, and research.
Methods
This is a retrospective cross-sectional study. A classification system was developed with five elements: micrognathia, nutrition, airway, palate, syndrome/comorbidities (MicroNAPS). Definitions and a framework for “stage” assignment (R0–R4) were constructed. Stage “tongue-based airway obstruction” (TBAO) was defined for infants with glossoptosis and UAO without micrognathia. MicroNAPS was applied to 100 infants with at least 1-year follow-up. Clinical course, treatment, airway, and feeding characteristics were assessed. Descriptive and analytic statistics were calculated and a P value less than 0.05 was considered significant.
Results
Of the 100 infants, 53 were male. Mean follow-up was 5.0 ± 3.6 years. R1 demonstrated feeding-predominant mild RS for which UAO was managed nonoperatively but gastrostomy tubes were prevalent. R2 was characterized by airway-predominant moderate RS, typically managed with mandibular distraction or tongue-lip adhesion, with few gastrostomy tubes and short lengths-of-stay. R3 denoted severe RS, with similar UAO treatment to R2, but with more surgical feeding tubes and longer admissions. R4 represented a complex phenotype with 33% tracheostomies, protracted hospitalizations, and delayed palatoplasty. R0 (“at risk”) and TBAO groups displayed the most variability.
Conclusions
MicroNAPS is easy to use and associated with relevant disease characteristics. We propose its adoption in clinical and research settings.
Objective:
To compare awake endoscopy with Müller's maneuver (MM) during both sitting and supine positions, with drug-induced sleep endoscopy (DISE) as regard determination of different levels, patterns, and degrees of collapse of the upper airway in adult patients with obstructive sleep apnea (OSA).
Methods:
The study included adult patients with OSA symptoms, who had apnea hypopnea index (AHI) > 15. Patients were examined by MM in a sitting position, then during supine position; DISE then followed. Site, pattern, and degree of obstruction were assessed by experienced examiners according to the nose oropharynx hypopharynx and larynx classification.
Results:
Eighty-one adult subjects were included. The most common pattern of collapse at the retro-palatal level was the concentric pattern, while the predominant pattern at the hypopharyngeal level was the lateral wall collapse. The analysis of the pattern of collapse of the study group revealed that the individual pattern did not change (for the same patient at the same level) in the majority of patients whatever the maneuver or the position.
Conclusion:
This study demonstrates the feasibility of positional awake endoscopy for providing valuable surgical information as regard level, pattern, and degree of severity in OSA. The data of positional awake endoscopy were comparable to those gained from DISE with less morbidity and costs. The idea and results of this work provide a useful foundation for future research in this area. Multicenter studies are encouraged to obtain more reliable conclusions and more clear standards aiming at a better surgical planning.
Level of evidence:
4 Laryngoscope, 2019.
Objective:
The role of hyoidthyroidpexia (HTP) surgery in the management of patients with obstructive sleep apnea (OSA) is well described with good reported outcomes. The effect of HTP on other laryngeal functions is not well discussed. This study was designed to evaluate voice and swallowing outcomes after HTP.
Patients and methods:
This study was applied on a selected group of OSA patients. HTP (as a sole procedure) was performed in 17 patients and 14 patients had simultaneous palatal procedures (e.g., anterior palatoplasty). Pre- and postoperative assessment of voice and swallowing were done.
Results:
Comparison between pre- and postoperative results of voice and swallowing measures revealed a nonsignificant difference.
Conclusion:
HTP (as a sole technique or as part of a multilevel intervention) could help with airway collapse and might be considered a safe, simple, and effective technique in the management of selected patients experiencing OSA. In addition, it seems to have no hazardous effect on either the voice or swallowing function of patients.
