Surgical treatment for obstructive sleep apnea: effect on sleep architecture.

PURPOSE: Investigate the effect of surgical treatment of obstructive sleep apnea syndrome (OSA) on sleep architecture. METHODS: Observational retrospective analysis of polysomnographic data of adults diagnosed with OSA, submitted to surgical treatment. Median (25-75th percentile) was used to present the data. RESULTS: Data were available for 76 adults, 55 men and 21 women, with median age of 49.0 years (41.0-62.0), body mass index of 27.3 kg/m2 (25.3-29.3) and AHI of 17.4 per hour (11.3-22.9) before surgeries. Preoperatively, 93.4% of patients had an abnormal distribution of at least one of the sleep phases. After surgical treatment, we found a significant increase in median N3 sleep percent from 16.9% (8.3-22-7) to 18.9% (15.5-25.4) (p = 0.003). Postoperatively, 18.6% patients that had an abnormal preoperative N1 sleep phase distribution had a normalization of this sleep phase, as also occurred to N2, N3 and REM sleep phases in 44.0%, 23.3% and 63.6% of patients, respectively. CONCLUSION: This study aims to show the impact of OSA treatment, not only on respiratory events but also on other polysomnographic data often underestimated. Upper airway surgeries have shown to be effective in sleep architecture improvements. There is a trend for sleep distribution normalization, with increase of time spend in profound sleep.

Swallowing evaluation in patients who underwent Partial CO2 LASER Epiglottectomy for Sleep Apnea treatment.

OBJECTIVE: To evaluate swallowing in patients who underwent CO2 LASER Partial Epiglottectomy (CO2-LPE) for Obstructive Sleep Apnea Syndrome and to assess the risk of aspiration with this technique. MATERIAL & METHODS: Chart review of adult patients who underwent CO2-LPE between 2016 and 2020, in a secondary care hospital. Patients underwent surgery for OSAS, in accordance to Drug Induced Sleep Endoscopy findings and an objective swallowing evaluation was done at least 6 months after surgery. Eating Assessment Tool (EAT-10) questionnaire was applied and Volume-Viscosity Swallow Test (V-VST) and Fiberoptic Endoscopic Evaluation of Swallowing (FEES) were performed. Dysphagia was classified according to Dysphagia Outcome Severity Scale (DOSS). RESULTS: Eight patients were included in the study. The mean time between surgery and the swallowing evaluation was 50 (±13,2) months. Only 3 patients presented ≥ 3 points on EAT-10 questionnaire. Two patients presented signs of decreased efficacy of swallowing (piecemeal deglutition) but none had a decrease in safety, according to V-VST. Although 50% of the patients presented some pharyngeal residue on FEES, it was classified as trace to mild in most of the cases. No evidence of penetration or aspiration was identified (DOSS ≥ 6 in all patients). CONCLUSION: The CO2-LPE is a potential treatment for OSAS patients with epiglottic collapse and no evidence of swallowing safety compromise was found.

Unilateral vocal fold paralysis as a port complication.

Unilateral vocal fold paralysis (UVFP) is a frequent finding in otorhinolaryngology practice, but its occurrence as a port complication was very rarely described in English Literature. The authors report a 55-year-old woman with a pancreatic adenocarcinoma who presented a left vocal fold paralysis that occurred concurrently with a venous thrombosis of the left subclavian vein, where a totally implantable venous-access had been previously placed. Although the patient's oncologic disease, that could mislead to a neoplastic cause of the UVFP, the authors came across with an unusual etiology and to their best knowledge, it is the first case of irreversible UVFP associated with onsite thrombosis of the vessel where a port was implanted. The objective of this article is to present and discuss this rare case of UVFP secondary to a port complication and to review the main mechanisms of iatrogenic vocal fold paralysis related to these devices.

Auditory Brainstem Response in Preterm Infants in the Neonatal Intensive Care Unit.

OBJECTIVE: To analyze auditory brainstem response (ABR) findings of preterm and term infants in the neonatal intensive care unit (NICU) with perinatal problems. STUDY DESIGN: Case series with chart review. SETTING: Secondary care hospital. METHODS: Analysis consisted of a consecutive series of 101 infants (69 preterm and 32 term) admitted in the NICU of Hospital Fernando Fonseca between 2016 and 2018 with perinatal problems who underwent an ABR evaluation. RESULTS: The major perinatal problems identified were hyperbilirubinemia, intravenous gentamicin >5 days, mechanical ventilation >5 days, congenital cytomegalovirus infection, meningitis, and periventricular hemorrhage. Gentamicin use significantly increased the absolute latency of wave I in preterm infants (95% CI, 0.01-0.37; P = .037). Mechanical ventilation significantly decreased the latency of wave V and intervals I-V and III-V in preterm infants (95% CI, -0.35 to -0.22; P = .026; 95% CI, -0.33 to -0.00; P = .001; 95% CI, -0.46 to 0.12; P = .049). Congenital cytomegalovirus significantly decreased interval III-V in preterm infants (95% CI, -0.36 to -0.01; P = .042).Multivariate analysis revealed that gentamicin use, lower gestational age, and lower birth weight predicted an increased ABR threshold in preterm infants (95% CI, 1.64-15.31; P = .016; 95% CI -1.72 to -0.09; P = .030; 95% CI, -14.55 to -0.63; P = .033). ABR measurements in term infants were not significantly altered, with the exception of an increased latency of wave III with a lower gestational age (95% CI, -0.49 to -0.01; P = .038). CONCLUSIONS: These findings suggest that perinatal problems in the NICU significantly impair the ABR threshold and the auditory pathway maturational process in preterm but not term infants.

Plants with neurobiological activity as potential targets for drug discovery.

Significant number of studies has been performed to find alternatives or treatments for diseases of the nervous forum by identifying structures with activity at the central nervous system (CNS). However most of the screenings are usually conducted on an ad hoc basis and not systematically. The initial purpose of this review was to screen plants with neurological bioactivity, in particular those that have not been fully studied and that have molecular mechanisms whose active constituents responsible for the activity remain to be identified. The second purpose was to identify potential target plants for future studies of new and alternative therapies for the treatment of neurological disorders and neurodegenerative diseases. All plants considered in this review were selected for three qualities: possible molecular requirements to act at the CNS; representative of the main classes of compounds with the referred bioactivity and the major families containing species with those compounds; and diffuse world distribution. We identified several examples of plants that have potential for further study. We have included the main families of these plants, their known molecular mechanisms involved in neurological bioactivity, and the active constituents responsible for such activity. Also included is a brief discussion about the requirements of the different compounds to reach the CNS. These requirements may be less limited than what researchers have previously thought.