Mouth Puffing Phenomenon and Upper Airway Features May Be Used to Predict the Severity of Obstructive Sleep Apnea.

Purpose: This study aimed to investigate (1) the role of mouth puffing phenomenon and upper airway features in obstructive sleep apnea (OSA) and (2) whether mouth-taping during sleep alleviated the severity of OSA. Participants and Methods: Seventy-one participants underwent a two-night home sleep test (the first day sleeping normally; the second day sleeping with their mouths being taped); their oximetry desaturation index (ODI) and mouth puffing signals (non-mouth puffing, complete mouth puffing, intermittent mouth puffing (IMP), and side mouth puffing) were detected by a validated fingertip pulse oximeter and a mouth puffing detector. The participants were grouped into the ODI-improved group and the ODI-not-improved group according to their sleeping test results. The radiograph was taken by cone-beam computed tomography and cephalometries. Upper airway features including airways, soft tissues, and oral cavity variables were measured. Results: Participants with severe OSA showed a higher IMP percentage compared with those with normal, mild, and moderate OSA (severe: 33.78%, moderate: 22.38%, mild: 14.55%, normal: 0.31%, p < 0.001). In all participants, the ODI and the percentage of SpO2 under 90 (T90) were positively related to body mass index (BMI) (r = 0.310 and 0.333, respectively), while ODI and T90 were negatively correlated with the minimum width of the airway (r = -0.473 and -0.474, respectively); all mentioned relationships were significant (p < 0.05). Conclusion: IMP proportions were found to be higher in the half of participants whose ODI did not improve after mouth-taping and in those with severe OSA. Moreover, OSA patients with higher ODI, higher T90, and higher proportions of IMP were more likely to have a narrower upper airway.

Mouth puffing phenomena of patients with obstructive sleep apnea when mouth-taped: device's efficacy confirmed with physical video observation.

PURPOSE: This study aimed to design a device to monitor mouth puffing phenomena of patients with obstructive sleep apnea when mouth-taped and to employ video recording and computing algorithms to double-check and verify the efficacy of the device. METHODS: A mouth puffing detector (MPD) was developed, and a video camera was set to record the patients' mouth puffing phenomena in order to make ensure the data obtained from the device was appropriate and valid. Ten patients were recruited and had polysomnography. A program written in Python was used to investigate the efficacy of the program's algorithms and the relationship between variables in polysomnography (sleep stage, apnea-hypopnea index or AHI, oxygen-related variables) and mouth puffing signals (MPSs). The video recording was used to validate the program. Bland-Altman plot, correlations, independent sample t-test, and ANOVA were analyzed by SPSS 24.0. RESULTS: Patients were found to mouth puff when they sleep with their mouths taped. An MPD was able to detect the signals of mouth puffing. Mouth puffing signals were noted and categorized into four types of MPSs by our algorithms. MPSs were found to be significantly related to relative OSA indices. When all participants' data were divided into minutes, intermittent mouth puffing (IMP) was found to be significantly different from non-mouth puffing in AHI, oxygen desaturation index (ODI), and time of oxygen saturation under 90% (T90) (AHI: 0.75 vs. 0.31; ODI: 0.75 vs. 0.30; T90: 5.52 vs. 1.25; p < 0.001). Participants with severe OSA showed a higher IMP percentage compared to participants with mild to moderate OSA and the control group (severe: 38%, mild-to-moderate: 65%, control: 95%; p < 0.001). CONCLUSIONS: This study established a simple way to detect mouth puffing phenomena when patients were mouth-taped during sleep, and the signals were classified into four types of MPSs. We propose that MPSs obtained from patients wearing the MPD can be used as a complement for clinicians to evaluate OSA.

Dynamic pain after laser-assisted-Uvulo-palatoplasty (LAUP) can instantaneously be mitigated by topical regimens.

BACKGROUND AND OBJECTIVES: Kenalog application onto surgical wounds has been used to control dynamic pain following Laser-Assisted-Uvulo-Palatoplasty (LAUP) with good results in our department. When the effect was sub-optimal, insufficient ointment over the superior-lateral corner of wounds were always noted. Fulfilling the coating led to optimal results, and preliminary trials showed a good outcome of dynamic pain control as well by treating the corners only. The corners were thus named "sweet spots." This study aimed to verify the efficacy of applying Kenalog on "sweet spots" instead of whole surgical wounds to mitigate dynamic pain due to LAUP. STUDY DESIGN/MATERIALS AND METHODS: This is an outcomes research. Fifty-five subjects with primary snoring treated with LAUP were studied. By using Kenalog, local treatments were applied to sweet spots during the first postoperative week. A visual analogous scale was used to evaluate dynamic pain on the 1st, 2nd, 3rd, and 7th days after LAUP. RESULTS: Once sweet spots were treated, there was instant alleviation of dynamic pain; the average improvement level was ≥80% (P < 0.001, power = 100%). The area of sweet spots, in contrast to the significant relief in dynamic pain, occupied only about 30% of denuded mucosa. CONCLUSIONS: Dynamic pain after LAUP could immediately be mitigated by local treatments upon sweet spots using topical regimens. The large-scale relief of dynamic pain in contrast to the small area of sweet spots implies a congregation of free nerve endings there. Our finding invites further studies to correlate the neuroanatomy of the soft palate and dynamic pain caused by LAUP.

A technique for quantifying and determining the site of isometric muscle fatigue in the clinical setting.

We investigated a clinically applicable technique for quantifying and determining the site of fatigue during isometric contraction. We measured torque in the right knee extensors of 17 able-bodied subjects during an isometric contraction for 60sec at 100%, 75%, 50%, and 25% of maximal effort. During contractions, a 0.5-sec train of 50-Hz stimulation was applied at 15, 30, and 45sec. We measured the percent decline in force over 60 sec (fatigue index) and average augmentation in torque during stimulation (AVAUGTORQ). The mean fatigue index at full effort was 25.1%. The mean AVAUGTORQ at 100%, 75%, 50%, and 25% of maximal effort was 12.1%, 26.3%, 40.5%, and 69.7% of values at complete relaxation, respectively. These methods should be clinically useful for quantifying the level of isometric fatigue, determining the site of fatigue, and measuring the level of effort in subjects without neuromuscular disease. The results agree with previous studies reporting a peripheral site of fatigue in healthy, well-motivated subjects.

Radio-frequency analysis of the effect of haloperidol and cyclo (leucyl-glycyl) on apomorphine-induced stereotypy.

Our previous studies indicated that the peptide cyclo(leucyl-glycyl) (cLG) prevents the development of supersensitivity to dopamine in several animal models at both biochemical and behavioral levels. We therefore tested cLG in a paradigm more commonly used to model tardive dyskinesia, namely chronic haloperidol administration to rats. We found that cLG administered subcutaneously at a dose of 8 mg/kg, blocked about 50% of the supersensitizing effects of of haloperidol on apomorphine-induced stereotypic behaviors. Further, we used a novel method, radio-frequency analysis, that quantifies sniffing and other stereotypic movements. Unlike methods that rely on visual observation of stereotypy and utilize an ordinal scale, these measurements are rated by an automatic motility monitor and utilize a ratio scale. Unlike other automated motility monitors, this device can distinguish between various forms of stereotypic behaviors. Since parametric statistics can be used, there is a significant improvement in the efficiency of the task of rating and comparing stereotypy scores.