ABSTRACT
OBJECTIVE: To compare patients with moderate-severe obstructive sleep apnea (OSA) undergoing traditional single and multilevel sleep surgery to those undergoing upper airway stimulation (UAS). STUDY DESIGN: Case control study comparing retrospective cohort of patients undergoing traditional sleep surgery to patients undergoing UAS enrolled in the ADHERE registry. SETTING: 8 multinational academic medical centers. SUBJECTS AND METHODS: 233 patients undergoing prior single or multilevel traditional sleep surgery and meeting study inclusion criteria were compared to 465 patients from the ADHERE registry who underwent UAS. We compared preoperative and postoperative demographic, quality of life, and polysomnographic data. We also evaluated treatment response rates. RESULTS: The pre and postoperative apnea hypopnea index (AHI) was 33.5 and 15 in the traditional sleep surgery group and 32 and 10 in the UAS group. The postoperative AHI in the UAS group was significantly lower. The pre and postoperative Epworth sleepiness scores (ESS) were 12 and 6 in both the traditional sleep surgery and UAS groups. Subgroup analysis evaluated those patients undergoing single level palate and multilevel palate and tongue base traditional sleep surgeries. The UAS group had a significantly lower postoperive AHI than both traditional sleep surgery subgroups. The UAS group had a higher percentage of patients reaching surgical success, defined as a postoperative AHI <20 with a 50% reduction from preoperative severity. CONCLUSION: UAS offers significantly better control of AHI severity than traditional sleep surgery. Quality life improvements were similar between groups.
Subject(s)
Electric Stimulation Therapy , Otorhinolaryngologic Surgical Procedures , Postoperative Complications , Quality of Life , Sleep Apnea, Obstructive , Airway Management/methods , Case-Control Studies , Comparative Effectiveness Research , Electric Stimulation Therapy/adverse effects , Electric Stimulation Therapy/methods , Female , Humans , Male , Middle Aged , Otorhinolaryngologic Surgical Procedures/adverse effects , Otorhinolaryngologic Surgical Procedures/methods , Outcome and Process Assessment, Health Care/statistics & numerical data , Palate/surgery , Polysomnography/methods , Polysomnography/statistics & numerical data , Postoperative Complications/diagnosis , Postoperative Complications/epidemiology , Sleep Apnea, Obstructive/diagnosis , Sleep Apnea, Obstructive/physiopathology , Sleep Apnea, Obstructive/therapy , Tongue/surgeryABSTRACT
BACKGROUND: Myofunctional therapy has demonstrated efficacy in treating sleep-disordered breathing. We assessed the clinical use of a new mobile health (mHealth) app that uses a smartphone to teach patients with severe obstructive sleep apnea-hypopnea syndrome (OSAHS) to perform oropharyngeal exercises. OBJECTIVE: We conducted a pilot randomized trial to evaluate the effects of the app in patients with severe OSAHS. METHODS: Forty patients with severe OSAHS (apnea-hypoxia index [AHI]>30) were enrolled prospectively and randomized into an intervention group that used the app for 90 sessions or a control group. Anthropometric measures, Epworth Sleepiness Scale (0-24), Pittsburgh Sleep Quality Index (0-21), Iowa Oral Performance Instrument (IOPI) scores, and oxygen desaturation index were measured before and after the intervention. RESULTS: After the intervention, 28 patients remained. No significant changes were observed in the control group; however, the intervention group showed significant improvements in most metrics. AHI decreased by 53.4% from 44.7 (range 33.8-55.6) to 20.88 (14.02-27.7) events/hour (P<.001). The oxygen desaturation index decreased by 46.5% from 36.31 (27.19-43.43) to 19.4 (12.9-25.98) events/hour (P=.003). The IOPI maximum tongue score increased from 39.83 (35.32-45.2) to 59.06 (54.74-64.00) kPa (P<.001), and the IOPI maximum lip score increased from 27.89 (24.16-32.47) to 44.11 (39.5-48.8) kPa (P<.001). The AHI correlated significantly with IOPI tongue and lip improvements (Pearson correlation coefficient -0.56 and -0.46, respectively; both P<.001). The Epworth Sleepiness Scale score decreased from 10.33 (8.71-12.24) to 5.37 (3.45-7.28) in the app group (P<.001), but the Pittsburgh Sleep Quality Index did not change significantly. CONCLUSIONS: Orofacial exercises performed using an mHealth app reduced OSAHS severity and symptoms, and represent a promising treatment for OSAHS. TRIAL REGISTRATION: Spanish Registry of Clinical Studies AWGAPN-2019-01, ClinicalTrials.gov NCT04438785; https://clinicaltrials.gov/ct2/show/NCT04438785.
Subject(s)
Mobile Applications , Myofunctional Therapy , Sleep Apnea, Obstructive , Aged , Female , Humans , Male , Middle Aged , Pilot Projects , Sleep , Sleep Apnea, Obstructive/therapyABSTRACT
Este documento pretende dar a conocer la endoscopia de sueño inducido entre los distintos especialistas que tratan a los pacientes con trastornos respiratorios del sueño y ser una guía para los especialistas que vayan a realizarla de modo que pueda ser reproducible
This document introduces drug-induced sleep endoscopy to the specialist treating sleep breathing disorders and is intended as a guide for those willing to perform the procedure so that it can be reproducible
Subject(s)
Humans , Practice Guidelines as Topic , Endoscopy/methods , Deep Sedation/methods , Sleep Apnea, Obstructive/diagnosis , Endoscopy/standards , Deep Sedation/standards , Sleep Apnea, Obstructive/therapy , Propofol/therapeutic use , Hypnotics and Sedatives/therapeutic use , Midazolam/therapeutic useABSTRACT
This document introduces drug-induced sleep endoscopy to the specialist treating sleep breathing disorders and is intended as a guide for those willing to perform the procedure so that it can be reproducible.
Subject(s)
Airway Obstruction/diagnosis , Endoscopy/methods , Pain, Procedural/prevention & control , Practice Guidelines as Topic , Sleep Aids, Pharmaceutical/administration & dosage , Sleep Apnea, Obstructive/diagnosis , Sleep , Video-Assisted Surgery/methods , Adult , Airway Obstruction/classification , Airway Obstruction/complications , Anesthetics, Local/administration & dosage , Computer Systems , Contraindications, Procedure , Endoscopy/adverse effects , Fiber Optic Technology , Humans , Infusion Pumps , Pain, Procedural/etiology , Paracentesis/methods , Patient Positioning , Sialorrhea/etiology , Sialorrhea/therapy , Sleep Apnea, Obstructive/etiology , Vasoconstrictor Agents/administration & dosage , Video-Assisted Surgery/adverse effectsABSTRACT
We introduce the first case reported to date of a floppy closing door epiglottis in an OSA (obstructive sleep apnea) patient treated successfully with an Mhealth smartphone application based on myofunctional therapy.
