Clinical Analysis of Daytime Sleepiness and Insomnia in Patients with Obstructive Sleep Apnea

BACKGROUND AND OBJECTIVES: Sleep disturbances and excessive daytime sleepiness (EDS) are the major symptoms of obstructive sleep apnea (OSA). This study aimed to investigate clinical implications of insomnia and EDS in patients with OSA using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). MATERIALS AND METHOD: We evaluated 131 subjects with suspected OSA who were undergoing polysomnography (PSG) and performing the PSQI and ESS surveys. OSA was diagnosed when the apnea-hypopnea index was five or more. EDS was defined when ESS score was 11 points or higher. Detailed history and questionnaire were used to categorize insomnia. We compared clinical variables and PSG results in subgroups with or without insomnia and EDS. RESULTS: There were no significant differences of PSQI and ESS score between controls and OSA. OSA with insomnia had significantly increased total score (p < 0.001) and decreased total sleep time (p=0.001) and sleep efficiency (p=0.001) on the PSQI compared to those without insomnia. OSA with EDS showed significantly increased PSQI score (p=0.022) and decreased total sleep time (p=0.018) on PSG compared to those without EDS. Neither PSQI nor ESS score had a correlation with respiratory variables such as AHI and oxygen saturation. Total sleep time had a significant effect on both insomnia and EDS in patients with OSA. CONCLUSION: Decreased total sleep time had important effects on subjective symptoms of OSA and comorbid insomnia. Therefore, restoration of decreased sleep time is important in the management of OSA.

Optimal Regimen and Period for the Treatment of Patients with Laryngopharyngeal Reflux Disease / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Various drugs can be used for treatment of laryngopharyngeal reflux disease (LPRD). However, the optimal medical treatment regimen is still controversial. This study was performed to determine the optimal medical treatment regimen and duration for LPRD. SUBJECTS AND METHOD: We studied 172 patients who were diagnosed as LPRD by reflux symptom index (RSI) or reflux finding scores (RFS). The study group was divided into 4 groups according to the medication regimen: proton pump inhibitor (PPI), PPI and prokinetics, PPI and H2 blocker, and double dose PPI groups. All patients took medicines for 3 months or more. Clinical remission was defined as 70% improvement of initial RSI scores. RESULTS: 36 (20.9%) patients were prescribed PPI only, 65 (37.8%) patients PPI with prokinetics, 51 (29.6%) patients PPI with H2 blocker, 20 (11.6%) patients double dose PPI. Pretreatment with RSI and RFS did not differ among the four groups. RSI was improved after one month of medication in all of the groups. RSI and RFS tended to decrease during the treatment in all groups (p for trend <0.001). The mean clinical remission time was 2.3 months in patients receiving PPI alone, 2.6 months in PPI and prokinetics group, 2.5 months in the PPI and H2 blocker group and 1.8 months in the double dose PPI group. About 70% of patients reached clinical remission within 3 months. CONCLUSION: PPI with or without prokinetics or H2 blocker is effective treatment for LPRD, and the appropriate duration of medication seems to be about 3 months. Double dose PPI can be used for those whom normal dose PPI is ineffective.

A Study of Pulmonary Thromboembolism after Head and Neck Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Pulmonary thromboembolism (PTE) after surgery is one of the rare but fatal complications causing sudden respiratory failure. This study was performed to evaluate PTE after head and neck surgery and to report our recent experience with review of the literature. SUBJECTS AND METHOD: We retrospectively analyzed 1096 patients who underwent head and neck surgery from January 2011 to June 2013 in a tertiary hospital. We evaluated the incidence and characteristics of PTE and risk factors of PTE such as smoking, body mass index, comorbidities, coronary artery disease, coagulation disorder and Caprini risk assessment model. RESULTS: PTE occurred in five of 1096 patients (0.46%; two were male and three were female, with a mean age of 56.2 year). All patients with PTE were categorized into high risk group of PTE by Caprini model. The mean Caprini risk score were 6.6 and 4.6 in the PTE patients and non-PTE patients, respectively. The significant risk factors were long operative time, cancer patients and high Caprini score in this study. One PTE patient underwent cardiopulmonary resuscitation due to respiratory arrest, afterwards received thromboembolectomy by thoracotomy. Four patients received anticoagulation therapy only. CONCLUSION: Risk stratification for PTE is necessary in patients who receive long operation for head and neck cancer or have high Caprini score.

A Case of Auditory Neuropathy with Recovery of Normal Hearing

Newborn hearing screening test is very important in the early diagnosis of childhood hearing loss because it affects language development. Auditory neuropathy is a spectrum disorder characterized by abnormal auditory brainstem response but preserved otoacoustic emission and cochlear microphonics. In general, auditory neuropathy patients have poor word discrimination and variable patterns of pure tone audiometry. We report on a patient with auditory neuropathy diagnosed at 16 months of age and started wearing hearing aids, but showed normal pure tone and speech audiometric findings 3 years later. Close follow-up for patients with auditory neuropathy is recommended.