Prognostic Factors for Improved Daytime Sleepiness after Uvulopalatal Flap for Obstructive Sleep Apnea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We aimed to evaluate pre-operative factors for patients with obstructive sleep apnea (OSA) and determine the correlation these factors have with the improvement of daytime sleepiness based on the change of Epworth Sleepiness Scale (ESS) score before and after uvulopalatal flap (UPF). SUBJECTS AND METHOD: Twenty-two patients with OSA who had received UPF surgery were enrolled in the study. We checked age, body mass index (BMI), size of tonsils, and position of palate. Using the Muller maneuver, we quantified the degree of obstruction at the velopharynx and the tongue base level. The cephalometric variables were checked by X-ray. Apnea-hypopnea index, respiratory distress index, and lowest oxygen saturation were obtained by portable monitoring. Finally, we obtained ESS score before and after UPF. The correlation between the aforementioned pre-operative factors and changes in ESS score was evaluated. RESULTS: A significant correlation was observed between the change in ESS score and patients' age (R=0.168, p=0.031), BMI (R=0.642, p=0.004), and posterior airway space (PAS)(R=0.378, p=0.029). Patients who were older than 40 years old (p=0.030), obese patients with BMI> or =25.0 (p=0.001), and those who had reported severe daytime sleepiness before surgery (pre-operative ESS score >10, p<0.01) reported greater improvement of daytime sleepiness after UPF. CONCLUSION: We propose age, BMI, and wider PAS as predictors for greater improvement of daytime sleepiness after UPF in patients with OSA.

Epileptic Nystagmus and Vertigo Associated with Bilateral Temporal and Frontal Lobe Epilepsy

Epileptic nystagmus is defined as a quick, repetitive jerky movement of the eyeball associated with seizure activity. In cases of epileptic nystagmus associated with ictal discharge from multiple brain areas, localization of the exact epileptogenic zone could be extremely difficult. In a nine-year-old patient with epileptic nystagmus and vertigo associated with bilateral temporal and frontal lobe epilepsy, we could infer the epileptic focus by interpreting the patient's clinical picture, characteristics of nystagmus, and findings of electroencephalography.