Immediate and Medium-Term Follow-Up of Patients with Obstructive Sleep Apnea Undergoing Pharyngeal and Nasal Surgery: A Pilot Study.

Objectives To evaluate the evolution of obstructive sleep apnea (OSA), comparing data from preoperative, immediate postoperative and late postoperative, in patients undergoing pharyngeal surgery associated with nasal surgery, and to compare the findings of arterial tonometry and type 1 polysomnography in the late postoperative period. Methods Seventeen adults with moderate or severe OSA were included in the study. They underwent clinical evaluation, surgical intervention, and sleep study preoperatively, on the 1 st night after surgery, and after a minimum period of 3 months. The data for the three moments were compared. Results The mean age was 38.1 ± 12.5 years old (22 to 59 years old), and 82.3% were male. Body mass index (BMI) ranged from 25.6 to 45.1 kg/m2 (mean = 33.1 ± 5.8 kg/m 2 ). Fifteen patients (88.2%) were diagnosed with severe OSA. There was a progressive improvement, with a decrease in the indexes (AHI and RDI) and in the percentage of time with peripheral oxyhemoglobin saturation below 90% (tSpO < 90%), and an increase in nadir of SpO2. In the comparison between the 2 methods used in the late postoperative period - arterial tonometry and polysomnography - there was no difference in the indexes and in the tSpO < 90%. Discussion There was a progressive and favorable impact of pharyngeal surgery on the improvement of polysomnographic and clinical respiratory parameters; however, many patients maintained residual OSA, suggesting the need for a new sleep study in the postoperative period. The arterial tonometry showed similar findings to polysomnography, which can be considered as an option in postoperative follow-up of patients.

Assessment of Laryngopharyngeal Reflux and Obstructive Sleep Apnea: A Population-Based Study.

OBJECTIVES/HYPOTHESIS: To evaluate the presence of laryngopharyngeal reflux (LPR) and the potential association between presence of LPR symptoms and obstructive sleep apnea (OSA) in a representative sample from a population-based study. STUDY DESIGN: Cross-sectional study. METHODS: Participants of the follow-up of the Epidemiological Sleep Study were evaluated. Sleep was assessed through questionnaires and polysomnography. The presence of LPR was based on the questionnaire Reflux Score Index (RSI), and scores higher than 13 were suggestive of LPR. A general linear model test was used for comparison of continuous data and Pearson's chi-square test was used to compare categorical variables. Predictors of LPR were obtained by regression analysis. RESULTS: 701 were enrolled (54.8% female, 45.2% male; mean age, 50.2 ± 13.3 years). The mean apnea-hypopnea index score was 17 ± 18.3 events/hr, and the mean RSI score was 7.0 ± 8.1. LPR was found in 17% of the volunteers, whereas OSA was present in 38.5% of the sample. Specifically, in those patients with OSA, the prevalence of LPR was 45.4%; however, there was no statistically significant association between LPR and the presence of OSA. The severity of OSA was not associated with RSI score. The presence of LPR was associated with older age, smoking, excessive daytime sleepiness and worse quality of life and sleep scores questionnaires. CONCLUSIONS: Age, smoking, but not body mass index, were associated with LPR. There was not statistically significant association of LPR with OSA. Individuals with symptoms of LPR had greater drowsiness and worse quality of life and sleep. LEVEL OF EVIDENCE: 3 Laryngoscope, 132:1877-1882, 2022.

Dysphagia in patients with moderate and severe obstructive sleep apnea.

INTRODUCTION: There is evidence that trauma caused by snoring in the pharynx could result in dysphagia in patients with obstructive sleep apnea, but the literature is still scarce to define the factors associated with the presence of dysphagia in these patients. OBJECTIVES: To analyze the occurrence of dysphagia and its clinical and polysomnographic features in patients with moderate and severe obstructive sleep apnea, in addition to verifying the impact of dysphagia on the quality of life of these patients. METHODS: Seventy patients with moderate or severe apnea (apnea and hypopnea index - AHI>15/hour) were selected. The patients underwent a sleep questionnaire, a quality of life in dysphagia questionnaire and a fiberoptic endoscopic evaluation of swallowing. RESULTS: A total of 70 patients were included in the study, of which 49 were men (70 %), with a mean age of 48.9 years. The fiberoptic endoscopic evaluation of swallowing was altered in 27.3 % and the most frequent alteration was the premature oral leakage with fluid. Comparing the groups with and without dysphagia, the female gender was the only clinical parameter that showed a trend of statistical significance in the group with dysphagia (p=0.069). There was no statistical difference regarding the polysomnographic features and in the global quality of life score in dysphagia in the comparison between the groups. CONCLUSIONS: The presence of dysphagia in patients with moderate to severe apnea is frequent and subclinical, reinforcing the need to investigate this symptom in this group of patients. However, the presence of dysphagia did not result in worsening in patients' quality of life, suggesting that, although frequent, its effect is mild. There was no relevance regarding the association of clinical and polysomnographic parameters with the presence of dysphagia.

Clinical and polysomnographic predictors of laryngopharyngeal reflux in obstructive sleep apnea syndrome / Avaliação do refluxo laringofaríngeo na síndrome da apneia obstrutiva do sono

Abstract Introduction Obstructive sleep apnea syndrome and laryngopharyngeal reflux are diseases with a high prevalence in the overall population; however, it remains unclear whether they are diseases with the same risk factors present in the same populations or if there is any association between them. Objectives To evaluate and determine the prevalence of laryngopharyngeal reflux in patients with moderate and severe obstructive apnea syndrome and also to determine its predictive factors. Methods Historical cohort, cross-sectional study of patients aged 18-70 years, referred to a tertiary service Otorhinolaryngology outpatient clinic with a polysomnographic diagnosis of moderate or severe obstructive sleep apnea syndrome. The reflux symptom index questionnaire and the reflux finding score at indirect videolaryngoscopy were applied to the assessed population, considering the inclusion and exclusion criteria. Results Fifty-six patients were evaluated, of which 64.3% had a positive laryngopharyngeal reflux (positive reflux symptom index and/or positive endolaryngeal reflux finding score). Body mass index was a predictor of reflux presence in this group of patients with moderate to severe obstructive sleep apnea syndrome. In patients with positive score for endoscopic findings and reflux symptom index (12.3%), there was a trend toward significance for a higher mean apnea-hypopnea index and a higher percentage of sleep time with oxyhemoglobin saturation below 90% (p = 0.05). Conclusion The prevalence of laryngopharyngeal reflux was higher in this group of patients with moderate to severe obstructive sleep apnea syndrome, and the body mass index was a predictor of laryngopharyngeal reflux in these patients. There was a trend toward greater oxyhemoglobin desaturation in patients with a positive score for reflux symptoms index (RSI) and reflux finding score (RFS).

Resumo Introdução A síndrome da apneia obstrutiva do sono e o refluxo laringofaríngeo são doenças com alta prevalência na população em geral. No entanto, ainda não está claro se são doenças com os mesmos fatores de risco presentes nas mesmas populações ou se há alguma relação entre elas. Objetivo Avaliar e determinar a prevalência de refluxo laringofaríngeo em pacientes com síndrome da apneia obstrutiva moderada e acentuada, bem como determinar os fatores preditivos de refluxo nesses pacientes. Método Estudo de coorte histórica com corte transversal de pacientes entre 18 e 70 anos, encaminhados a um ambulatório de Otorrinolaringologia em serviço terciário, com diagnóstico polissonográfico de síndrome da apneia obstrutiva do sono moderada ou acentuada. Foram aplicados o questionário Reflux Sympton Index e o escore de achados endolaríngeos por meio de videolaringoscopia indireta na população estudada, respeitando os critérios de inclusão e exclusão. Resultados Foram avaliados 56 pacientes, dos quais 64,3% apresentaram refluxo laringofaríngeo (Reflux Sympton Index positivo e/ou Reflux Finding Score positivo). O índice de massa corpórea foi fator preditor da presença de refluxo laringofaríngeo nesse grupo de pacientes com síndrome da apneia obstrutiva do sono moderada e acentuada. Nos pacientes cujos Reflux Sympton Index e o escore de achados endolaríngeos foram positivos (12,3%), houve uma tendência à significância para maior índice de apneia e hipopneia e maior porcentagem do tempo de sono com saturação de oxi-hemoglobina abaixo de 90% (p = 0,05). Conclusão A prevalência de refluxo laringofaríngeo foi alta nesse grupo de pacientes com síndrome da apneia obstrutiva do sono moderada e acentuada e o índice de massa corpórea foi fator preditor de refluxo nesses pacientes. Houve uma tendência a maior dessaturacão de oxi-hemoglobina em pacientes com "índice de sintomas de refluxo" e escore de achados endolaríngeos positivos.

Clinical and polysomnographic predictors of laryngopharyngeal reflux in obstructive sleep apnea syndrome.

INTRODUCTION: Obstructive sleep apnea syndrome and laryngopharyngeal reflux are diseases with a high prevalence in the overall population; however, it remains unclear whether they are diseases with the same risk factors present in the same populations or if there is any association between them. OBJECTIVES: To evaluate and determine the prevalence of laryngopharyngeal reflux in patients with moderate and severe obstructive apnea syndrome and also to determine its predictive factors. METHODS: Historical cohort, cross-sectional study of patients aged 18-70 years, referred to a tertiary service Otorhinolaryngology outpatient clinic with a polysomnographic diagnosis of moderate or severe obstructive sleep apnea syndrome. The reflux symptom index questionnaire and the reflux finding score at indirect videolaryngoscopy were applied to the assessed population, considering the inclusion and exclusion criteria. RESULTS: Fifty-six patients were evaluated, of which 64.3% had a positive laryngopharyngeal reflux (positive reflux symptom index and/or positive endolaryngeal reflux finding score). Body mass index was a predictor of reflux presence in this group of patients with moderate to severe obstructive sleep apnea syndrome. In patients with positive score for endoscopic findings and reflux symptom index (12.3%), there was a trend toward significance for a higher mean apnea-hypopnea index and a higher percentage of sleep time with oxyhemoglobin saturation below 90% (p=0.05). CONCLUSION: The prevalence of laryngopharyngeal reflux was higher in this group of patients with moderate to severe obstructive sleep apnea syndrome, and the body mass index was a predictor of laryngopharyngeal reflux in these patients. There was a trend toward greater oxyhemoglobin desaturation in patients with a positive score for reflux symptoms index (RSI) and reflux finding score (RFS).

Tontura de origem labiríntica / Labyrinthine dizziness

A tontura é um sintoma associado a inúmeras condições clínicas e recruta a necessidade de investigação diagnóstica minuciosa e abordagem terapêutica individualizada. Muitas vezes associada ao zumbido, mais frequentemente relaciona-se a distúrbios do sistema vestibular periférico. Constituinte sintomático de um rol significativo de doenças, apresenta interface em várias especialidades médicas, o que denota a real necessidade de amplo conhecimento das condições a ela associadas. O presente estudo apresenta, sob a óptica de opinião de especialistas, uma abordagem relacionada ao diagnóstico e tratamento da tontura, considerando as necessidades dos médicos clínicos.

Dizziness is a symptom associated with numerous medical conditions and it recruits detailed diagnostic investigation and individualized therapeutic approach. It is often associated with tinnitus and related to disorders of peripheral vestibular system. It is present in a significant number of diseases and its occurrence in various medical specialties became essential the real need for extensive knowledge of the conditions associated with it. This study presents the viewpoint of expert opinion, an approach related to the diagnosis and treatment of dizziness, considering the necessities of physicians.

Labirintopatias / Labyrinthitis

A tontura é um sintoma associado a inúmeras condições clínicas e recruta a necessidade de investigação diagnóstica minuciosa e abordagem terapêutica individualizada. Muitas vezes associada ao zumbido, mais frequentemente se relaciona a distúrbios do sistema vestibular periférico. Constituinte sintomático de um rol significativo de doenças, apresenta interface em várias especialidades médicas, o que denota a real necessidade de amplo conhecimento das condições a ela associadas. O presente estudo apresenta, sob a óptica de opinião de especialistas, uma abordagem relacionada ao diagnóstico e tratamento da tontura.