Ankyloglossia in Children, a Cause of Obstructive Sleep Apnoea: Case Report of Paediatric Ankyloglossia and Sleep Apnoea: DISE Resolves the Mystery.

Tongue mobility is an obstructive sleep apnoea (OSA) marker and myofunctional therapy (MFT) target. For this reason, all paediatric patients with sleep-disordered breathing should require a combined functional assessment from an ear, nose, and throat (ENT) specialist and a phonoaudiologist to confirm or rule out the presence of ankyloglossia. To our knowledge, this is the first case of a 13-year-old girl diagnosed with severe OSA and a significant decrease of 94% in her apnoea index (AI), requiring frenotomy with an immediate postoperative change in the tongue position. A drug-induced sleep endoscopy (DISE) was performed before and immediately postfrenotomy, and the anatomical changes provoked by this surgery during sleep were confirmed for the first time.

Risk of cancer in patients with sleep apnea: comparison of surgery versus CPAP in a long-term follow-up study.

PURPOSE: This study aimed to obtain a comprehensive view of the risk of developing cancer in patients with obstructive sleep apnea (OSA) and to compare this risk between patients receiving continuous positive airway pressure (CPAP) therapy versus upper airway surgery (UAS). METHODS: We used both local data and a global-scale federated data research network, TriNetX, to access electronic medical records, including those of patients diagnosed with OSA from health-care organizations (HCOs) worldwide. We used propensity score matching and the score-matched analyses of data for 5 years of follow-up, RESULTS: We found that patients who had undergone UAS had a similar risk of developing cancer than those who used CPAP [hazard ratio of 0.767 (95% CI 0.559-1.053; P = 0.100)]. CONCLUSION: Analysis of the large data sets collected from HCOs in Europe and globally lead us to conclude that in patients with OSA, neither CPAP nor UAS were associated with the development of cancer better than in non-treated patients.

Reply to: Letter to the Editor of Journal of Otolaryngology regarding "Risk of diabetes in patients with sleep apnea: comparison of surgery versus CPAP in a long-term follow-up study".

A recent Letter published, in the Journal of Otolaryngology-Head & Neck Surgery in response to our original article "Risk of diabetes in patients with sleep apnea: comparison of surgery versus Continous Positive Airway Pressure in a long-term follow-up study" raised some issues we would like to address here. However, we thank the authors for their effort and time in analyzing our manuscript and we want to facilitate a balanced discussion on this topic with our reply.

Improving Adherence to Myofunctional Therapy in the Treatment of Sleep-Disordered Breathing.

Myofunctional therapy (MT) is used to treat sleep-disordered breathing. However, MT has low adherence-only ~10% in most studies. We describe our experiences with MT delivered through a mobile health app named Airway Gym®, which is used by patients who have rejected continuous positive airway pressure and other therapies. We compared ear, nose, and throat examination findings, Friedman stage, tongue-tie presence, tongue strength measured using the Iowa oral performance instrument (IOPI), and full polysomnography before and after the 3 months of therapy. Participants were taught how to perform the exercises using the app at the start. Telemedicine allowed physicians to record adherence to and accuracy of the exercise performance. Fifty-four patients were enrolled; 35 (64.8%) were adherent and performed exercises for 15 min/day on five days/week. We found significant changes (p < 0.05) in the apnoea-hypopnoea index (AHI; 32.97 ± 1.8 to 21.9 ± 14.5 events/h); IOPI score (44.4 ± 11.08 to 49.66 ± 10.2); and minimum O2 saturation (80.91% ± 6.1% to 85.09% ± 5.3%). IOPI scores correlated significantly with AHI after the therapy (Pearson r = 0.4; p = 0.01). The 19 patients who did not adhere to the protocol showed no changes. MT based on telemedicine had good adherence, and its effect on AHI correlated with IOPI and improvement in tongue-tie.

Non-acid reflux and sleep apnea: the importance of drug induced sleep endoscopy.

BACKGROUND: We present the first case of a patient with obstructive sleep apnea syndrome (OSA), where drug induced sleep endoscopy was helpful to suspect a non-acid reflux disease and showed an improvement in a swollen epiglottis after treatment. Patient ameliorated significantly his disease only with medical therapy. CASE PRESENTATION: A 54-year-old man without significant anatomical findings with obstructive sleep apnea syndrome and non-acid gastroesophageal reflux disease (GERD) disease whose Apnea- hypopnea index (AHI) was significantly reduced with the intake of 500 mg of sodium alginate twice a day for 6 months. Conventional digestive tests such as esophagoscopy and simple- and double-channel 24-h pH-metry suggested mild GERD. Conventional proton-pump inhibitor treatment with pantoprazole (40 mg daily) was started without any improvement in his sleep. Multichannel intraluminal 24-h impedanciometry indicated the presence of severe pathological GER of gaseous origin. The patient's AHI decreased from 25.3 at baseline to 8 after treatment with sodium alginate. A drug-induced sleep endoscopy study showed the changes before and after this treatment and was helpful for the diagnosis. CONCLUSIONS: Thus, medical treatment can be a therapeutic option in some patients with OSA. Multichannel 24-h impedanciometry should be performed when nonacid GERD is suspected.

Myofunctional Therapy App for Severe Apnea-Hypopnea Sleep Obstructive Syndrome: Pilot Randomized Controlled Trial.

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.

Tongue peak pressure: a tool to aid in the identification of obstruction sites in patients with obstructive sleep apnea/hypopnea syndrome.

Purpose of this study was to evaluate whether tongue peak pressure measured using the Iowa Oral Performance Instrument is correlated with the topographic site of obstruction in patients with obstructive sleep apnea/hypopnea syndrome observed during drug-induced sleep endoscopy. Thirty-five consecutive adult patients (29 men, 6 women) were prospectively enrolled after having been diagnosed with severe obstructive sleep apnea/hypopnea syndrome by polysomnography. An apnea-hypopnea index > 30 was confirmed, and age, gender, and body mass index were recorded by Epworth Sleepiness Scale questionnaire, and a thorough evaluation of the upper airway by video-flexible endoscopy. Twenty healthy controls according to age and sex were chosen for IOPI measurements. After drug-induced sleep endoscopy, a topographic diagnosis was done using the VOTE classification. Tongue and lip peak pressures were both measured using the Iowa Oral Performance Instrument in all patients and in 20 healthy controls. Main outcomes and measures: the correlations between office findings, Iowa Oral Performance Instrument measures, and the VOTE tongue classification during drug-induced sleep endoscopy (T0, T1, T2) were then investigated. RESULTS: The average Iowa Oral Performance Instrument tongue and lip pressure were 44.02 ± 12.29 and 15.03 ± 3.71 kPa, respectively. The Iowa Oral Performance Instrument scores were both significantly lower than values in healthy controls (P < 0.001). The VOTE classification referring to the tongue position was T0 in 13 cases (37.1%), T1 in 12 cases (34.3%), and T2 in 10 cases (28.6%). A significant correlation was found between the Iowa Oral Performance Instrument tongue pressure and the T size during drug-induced sleep endoscopy (Kruskal-Wallis χ2 25.82; P ≤ 0.001). CONCLUSIONS: In our experience, the Iowa Oral Performance Instrument is a useful tool for evaluating tongue collapse for the topographic diagnosis of patients with obstructive sleep apnea/hypopnea syndrome.

Floppy Closing Door Epiglottis Treated Successfully with an Mhealth Application Based on Myofunctional Therapy: A Case Report.

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.

Bipolar radiofrequency uvulopalatoplasty combined with injection snoreplasty: a reasonable option for the problem of snoring.

OBJECTIVES: The aim of this study was to assess the effectiveness and morbidity of the combined use of bipolar radiofrequency uvulopalatoplasty and a sclerosing agent applied to the soft palate in patients with snoring and apnea during a 1-year follow-up period. METHODS: This was a prospective, nonrandomized study. Twenty-eight patients with primary snoring due to palatal flutter who fulfilled the inclusion criteria were enrolled. Under local anesthesia, a single procedure uvulopalatoplasty using bipolar radiofrequency applied with sterilized forceps was undertaken in combination with a sclerosing agent. RESULTS: Four patients required a repeat procedure 6 weeks after the initial operation. The postoperative Epworth Sleepiness Scale score improved significantly 360 days after surgery. Snoring, measured on the Visual Analogue Scale, decreased from 8.9 +/- 0.7 to 4.1 +/- 1.4 (p < 0.005). No complications were reported. The average reduction on the apnea-hypopnea index was from 24.2 +/- 7.1 to 12.8 +/- 4.4 (p < 0.005). CONCLUSION: Bipolar radiofrequency uvulopalatoplasty combined with injection snoreplasty is an ambulatory, cost-effective, simple, and safe method to reduce the occurrence and effects of snoring and apnea.

Snoring surgery with palatal implants after failed uvulopalatopharyngoplasty.

The aim of this study was to assess the efficacy and morbidity in the use of the palatal implant technique (PITs) in patients with failed uvulopalatopharyngoplasty (UPPP) after a 6-month follow-up period. This was a prospective, nonrandomized study. Sixteen patients who underwent UPPP by the same Institution with Fujita's technique with initial success but developed posterior residual apnea or snoring who fulfilled the inclusion criteria were enrolled. Responses of all patients and their partners were assessed using the visual analogue scale (VAS) and the Epworth sleepiness scale (ESS). Objective data were recorded using ambulatory polysomnography before and at 6 months after surgery. Postoperative VAS and ESS scores significantly improved by 180 days after surgery (P < 0.005). VAS snoring score was reduced from 8.3 +/- 0.8 to 5.5 +/- 1.7 (P < 0.005) and ESS score decreased from 13.3 +/- 5.9 to 10.25 +/- 4.6 (P< 0.005). The apnea-hypopnea index (AHI) decreased from 18.08 +/- 6.02 to 16.8 +/- 5.05 events/h (P = 0.03). The PIT is an effective treatment for snoring and daytime sleepiness of patients with failed UPPPs.

Radiofrequency volumetric tissue reduction for treatment of turbinate hypertrophy in children.

BACKGROUND: Inferior turbinate hypertrophy is one of the most common causes of nasal airway obstruction in children. Medical treatment often produces very little improvement. Radiofrequency therapy has recently been shown to be safe and effective in volumetric tissue reduction of the turbinates in adults, but no report has been published about its use in children. We prospectively evaluated the safety and effectiveness of radiofrequency volumetric tissue reduction (RVTR) for the treatment of nasal obstruction caused by inferior turbinate hypertrophy in children. METHODS: We followed up 93 children less than 9 years of age who underwent RVTR over 12 months. This surgery was performed with other procedures, such as tonsillectomy with or without grommet insertion (57 patients), tympanoplasty (10 patients), or grommet insertion alone (26 patients). Clinical examination, a medical questionnaire, and scores recorded pre- and postoperatively using Gertner-Podoshin plates were used to assess treatment outcomes 1 month, 6 months and 1 year after surgery. RESULTS: No adverse effects were encountered. One primary bleed due to tonsillectomy was the only complication in this group. Eighty-seven children (94%) had significantly improved nasal breathing postoperatively. CONCLUSIONS: The results of this study demonstrate that RVTR is a safe, effective method for the treatment of turbinate hypertrophy in children. In addition, our data demonstrates good patient acceptance over a period of 1 year.