Association of Sleep Characteristics with Tinnitus and Hearing Loss.

Objective: The impact of poor sleep on tinnitus has been mainly attributed to central processes. There is an association between sleep disorders and hearing loss, but whether hearing levels mediate the association between sleep disorders and tinnitus is unknown. This study investigates the association between sleep characteristics, tinnitus, and hearing loss. Study Design: Cross-sectional. Setting: National Health and Nutrition Examination Survey (NHANES). Methods: Study cohort includes 9693 adults (≥20 years) from the NHANES 2005 to 2018 who completed audiometric testing and questionnaires on tinnitus and sleep characteristics. Multivariable regression analyses were performed to quantify associations between sleep characteristics, tinnitus, and hearing loss. Results: In this cohort, 29% (95% confidence interval [CI]: 28%-31%) reported trouble sleeping and 9% (95% CI: 8%-10%) reported being diagnosed with sleep disorders. Negative sleep characteristics (less hours of sleep, diagnosis of a sleep disorder, trouble sleeping, or OSA symptoms) were not associated with audiometry-measured hearing loss in multivariable models adjusted for demographics and comorbidities but were significantly associated with bothersome tinnitus. This association remained significant without substantial attenuation in multivariable models additionally adjusting for hearing levels: sleeping <8 h/day (vs ≥8) (odds ratio [OR]: 1.28 [95% CI: 1.08-1.52]), trouble sleeping (OR: 1.78 [95% CI: 1.45-2.19]), diagnosis of sleep disorders (OR: 1.57 [95% CI: 1.14-2.15]), and report of OSA symptoms (OR: 1.42 [95% CI: 1.08-1.88]). Conclusion: Negative sleep characteristics were associated with tinnitus while there was no clinically meaningful association between sleep and hearing loss. Our findings suggest that the relationship between poor sleep and tinnitus is likely contributed by central processes without a major role of mediation via the peripheral auditory system.

Posterior Palatal Expansion via Subnasal Endoscopy (2PENN) for Maxillary Deficiency: A Pilot Study.

OBJECTIVE: Surgically assisted rapid palatal expansion (SARPE) addresses transverse maxillary deficiency, a known contributor to nasal obstruction. The purpose of this study was to assess the feasibility, preliminary outcomes, and safety of posterior palatal expansion via subnasal endoscopy (2PENN), a modified SARPE procedure, aimed at achieving anterior and posterior maxillary expansion. METHODS: This prospective case series included consecutive adult patients with findings of transverse maxillary deficiency that underwent the 2PENN procedure from 4/2021 to 4/2022. Patients completed pre- and post-operative clinical evaluations, Nasal Obstruction and Septoplasty Effectiveness (NOSE) questionnaires, and computed tomography (CT), with measures including expansion at the level of the posterior nasal spine (PNS), first maxillary inter-molar distance (IMD), and anterior nasal spine (ANS). RESULTS: The cohort (N = 20) was middle-aged (39 ± 11 years), predominantly male (80%), and overweight (BMI 28 ± 4 kg/m2 ). The majority (85%) of patients had sleep breathing issues, of which 10 (59%) had polysomnography-confirmed obstructive sleep apnea (OSA). Full anterior-posterior separation of the mid-palatal suture line was evident on all post-operative CT scans, with mean expansion at the PNS of 3.6 ± 1.3 mm, IMD of 6.1 ± 1.6 mm and ANS of 7.0 ± 1.6 mm (p < 0.001). Following surgery, mean NOSE scores improved from 57 ± 23 to 14 ± 13 (p < 0.001). One patient required maxillary antrostomy for post-operative sinusitis. CONCLUSION: 2PENN is an effective and safe technique for achieving both anterior and posterior maxillary expansion in patients with transverse maxillary deficiency. Further study is warranted to better understand the effect of 2PENN in patients with OSA, particularly as it relates to improving pharyngeal patency. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:1970-1977, 2024.

Enhanced drug-induced sleep endoscopy: Distinguishing central from obstructive apnea.

This case report describes a patient originally diagnosed with obstructive sleep apnea (OSA) who was later found to have central sleep apnea (CSA) during drug-induced sleep endoscopy, which was subsequently confirmed on an in-laboratory sleep study. The revised diagnosis resulted in a change in recommended therapy from hypoglossal nerve stimulation to phrenic nerve stimulation. This case report is a reminder that the sleep surgeon must be cognizant of the possibility of CSA being misclassified as OSA especially as home sleep studies become increasingly routine, and discusses ways to more easily distinguish between CSA and OSA. Laryngoscope, 133:706-708, 2023.

Dextrocardia como hallazgo incidental: revisión a partir de un caso / Dextrocardia as incidental finding: review from a case

INTRODUCTION: Dextrocardia is characterized by the positioning of the heart to the right of the thoracic cavity, usually with the apex oriented to the right and its inverse anatomy 1,2. It is a rare congenital pathology that can be associated with other congenital cardiac anomalies, as well as a change in position of all thoracoabdominal structures 1-4. Its diagnosis in adult life is usually incidental. We present the clinical case of a 64-year-old man with an electrocardiogram that showed deviation of the QRS complex axis to the extreme right and a physical examination compatible with dextrocardia, which was later confirmed with images. OBJECTIVES: To review the medical literature related to the diagnosis of dextrocardia through the presentation of a clinical case. METHODS: The clinical data of the case were collected by means of anamnesis, physical examination and specialized exams of the patient, as well as his clinical file. The literary review was made using the MEDLINE® search engine for scientific journals. RESULTS: Dextrocardia affects less than 1% of the general population according to the studies reviewed. Its importance lies in the association with other congenital pathologies such as cardiac and extracardiac structural malformations, which increases morbidity and mortality in this group of patients. It is imperative, when suspected, complete the study with images that allow confirming or ruling out other structural anomalies.

Measuring diet quality in health personnel of a Chilean hospital using the Healthy Eating Index / Calidad de la dieta del personal de salud de un hospital chileno según el índice de alimentación saludable

Abstract Introduction: Evidence has shown that personnel working in hospital services have a high probability of developing modifiable risk factors associated with noncommunicable diseases such as poor nutrition, high levels of stress, changes of sleep patterns and a sedentary lifestyle. Objective: To assess diet quality among health personnel who eat at the cafeteria of the Hospital Regional de Temuco based on their work shifts, sex, and age. The Healthy Eating Index (HEI) was used to measure diet quality. Materials and methods: Cross-sectional study conducted on 201 workers (156 women and 45 men) who were asked to complete a survey on food consumption in order to evaluate their individual HEI. The questionnaire was divided by food groups. Results: The average age was 34.8±10.7 years and the average HEI score was 67.5 ± 14.5. 12.9% of the participants had unhealthy eating habits, 65.2% required dietary changes, and 21.9% had a healthy diet. Statistically significant differences were observed with respect to the HEI score according to sex (p=0.033) and age (p=0.009). No statistically significant differences were found between the HEI score and the shift system (p=0.334). Conclusions: Most participants need to modify their eating habits. Therefore, hospitals, as a workplace, should implement actions that promote the adoption of healthy eating habits among their staff, particularly in the case of men, who had significantly low HEI scores in several food groups compared to women.

Resumen Introducción. Se ha reportado que los trabajadores hospitalarios tienen una alta probabilidad de presentar factores de riesgo modificables asociados al desarrollo de enfermedades crónicas no transmisibles, tales como mala alimentación, altos niveles de estrés y cambios de los patrones del sueño. Objetivo. Determinar la calidad de la dieta del personal de salud que usa los servicios del Casino de Funcionarios de Hospital Dr. Hernán Henríquez Aravena de Temuco, Chile, de acuerdo a sistemas de turno, sexo y edad. Para la medición de la calidad de la dieta se utilizó el índice de alimentación saludable (IAS). Materiales y métodos. Estudio transversal realizado en 201 trabajadores (156 mujeres y 45 hombres), a quienes se les solicitó completar una encuesta sobre consumo de alimentos para evaluar sus IAS; el instrumento estuvo dividido por grupos de alimentos. Resultados. La edad promedio de la muestra fue 34.8±10.7 años y el puntaje promedio de IAS fue 67.5±14.5. El 12.9% de los participantes tenía hábitos alimenticios poco saludables, el 65.2% requería cambios dietarios y el 21.9% presentaba una alimentación saludable. Se observaron diferencias estadísticamente significativas respecto al IAS según sexo (p=0.033) y edad (p=0.009), pero no entre puntaje del IAS y el sistema de turnos (p=0.334). Conclusiones. La mayoría de los participantes necesita modificar sus hábitos alimenticios, por lo que es necesario que en los hospitales, como lugar de trabajo, se implementen acciones que promuevan la adopción de hábitos alimenticios saludables por parte del personal de salud, en particular en el caso de los hombres, quienes tuvieron puntajes de IAS significativamente bajos en varios grupos de alimentos en comparación con las mujeres.

The Association of Sleep Apnea and Cancer in Veterans.

OBJECTIVE: To test the association between preexisting obstructive sleep apnea (OSA) and subsequent cancer in a large long-term cohort of veteran patients. STUDY DESIGN: Retrospective matched cohort study. SETTING: The Veterans Affairs Health Care System. SUBJECTS AND METHODS: All veteran patients diagnosed with OSA between 1993 and 2013 by International Classification of Diseases, Ninth Revision (ICD-9) codes in any Veterans Affairs facility and veteran patients without an OSA diagnosis, matched to patients with OSA by age and index year. Cancer diagnoses were identified by ICD-9 codes for the time period at least 2 years after OSA diagnosis or index date. We tested the association between OSA and cancer using multivariate Cox regression with time since cohort entry as the time axis, adjusting for potential confounders. RESULTS: The cohort included 1,377,285 patients (726,008 with and 651,277 without an OSA diagnosis) with mean age of 55 years, predominantly male (94%), a minority obese (32%), and median follow-up of 7.4 years (range, 2.0-25.2). The proportion of patients diagnosed with cancer was higher in those with vs without an OSA diagnosis (8.3% vs 3.6%; mean difference 4.8%; 95% confidence interval [CI], 4.7%-4.8%; P < .001). After adjusting for age, sex, year of cohort entry, smoking status, alcohol use, obesity, and comorbidity, the hazard of incident cancer was nearly double in patients with vs without an OSA diagnosis (hazard ratio, 1.97; 95% CI, 1.94-2.00; P < .001). CONCLUSION: Preexisting OSA was strongly associated with subsequent cancer in this veteran cohort, independent of several known cancer risk factors. These findings suggest that OSA may be a strong, independent risk factor for subsequent cancer development.

Association of Continuous Positive Airway Pressure Treatment With Sexual Quality of Life in Patients With Sleep Apnea: Follow-up Study of a Randomized Clinical Trial.

Importance: Obstructive sleep apnea reduces sexual quality of life (QOL) as a result of reduced libido and intimacy, erectile dysfunction, and several other mechanisms. Treatment for obstructive sleep apnea may improve sexual QOL. Objective: To test the association of long-term continuous positive airway pressure (CPAP) treatment with sexual QOL for patients with obstructive sleep apnea. Design, Setting, and Participants: Prospective cohort study at a single, tertiary medical center of patients with newly diagnosed obstructive sleep apnea who were prescribed CPAP treatment from September 1, 2007, through June 30, 2010 (follow-up completed June 30, 2011). The statistical analysis was performed from February 1 through December 31, 2017. Exposures: Use of CPAP treatment objectively measured by the number of hours per night. Users of CPAP were defined as patients who used CPAP treatment for more than 4 hours per night, and nonusers were defined as patients who used CPAP treatment for fewer than 0.5 hours per night. Main Outcomes and Measures: Data were collected from eligible patients before CPAP treatment was prescribed and 12 months later by using the validated Symptoms of Nocturnal Obstruction and Related Events-25 (SNORE-25) QOL instrument. The 2 sex-specific items used to create the sexual QOL domain were taken from the SNORE-25. The sexual QOL domain was scored in a range from 0 to 5 (higher score is worse). The difference in sexual QOL between CPAP users and nonusers was analyzed using a paired, 2-tailed t test and multivariable linear regression adjusted for potential confounders. Results: Of the 182 participants in the cohort, 115 (63.2%) were men (mean [SD] age, 47.2 [12.3] years) with severe OSA (mean [SD] apnea-hypopnea index, 32.5 [23.8] events per hour). At the 12-month follow-up, 72 CPAP users (mean [SD] use, 6.4 [1.2] hours per night) had greater improvement than 110 nonusers (0 [0] hours per night) in sexual QOL scores (0.7 [1.2] vs 0.1 [1.1]; difference, 0.54; 95% CI, 0.18-0.90; effect size, 0.47). A moderate treatment association was observed after adjustment for age, sex, race/ethnicity, marital status, income level, educational level, body mass index, apnea-hypopnea index, and the Functional Comorbidity Index (adjusted difference, 0.49; 95% CI, 0.09-0.89; effect size, 0.43). Subgroup analysis revealed a large treatment association for women (adjusted difference, 1.34; 95% CI, 0.50-2.18; effect size, 0.87) but not for men (adjusted difference, 0.16; 95% CI, -0.26 to 0.58; effect size, 0.19). Conclusions and Relevance: Successful CPAP use may be associated with improved sexual QOL. Subgroup analysis revealed a large improvement in women but no improvement in men. Further study is warranted to test other measures of sexual QOL and other treatments. Trial Registration: ClinicalTrials.gov Identifier: NCT00503802.

Association of palatine tonsil size and obstructive sleep apnea in adults.

OBJECTIVE: The relationship between palatine tonsil (PT) size and obstructive sleep apnea (OSA) has not been well established in adults. The purpose of this study was to test the association between PT grade, PT volume, and OSA severity in U.S. adult patients. STUDY DESIGN: Cross-sectional study of all patients (age ≥ 18 years) who underwent pharyngeal surgery for OSA that included palatine tonsillectomy with tonsil volume measurement from January 2011 to June 2016. METHODS: Medical records were reviewed for PT grade (measured on clinical exam by the Brodsky tonsil grading scale), PT volume (measured intraoperatively by water displacement), and apnea-hypopnea index (AHI). Associations were evaluated with multivariate linear regression adjusting for age, sex, body mass index (BMI), smoking status, lingual tonsil volume (AHI models only), and multilevel surgery aside from lingual tonsillectomy (PT volume vs. AHI model only). RESULTS: The cohort (N = 83) was middle-aged (mean age 43 ± 12 years), predominantly male (61%), obese (mean BMI 33 ± 7 kg/m2 ), and had severe OSA (mean AHI 32 ± 28). After adjustment for confounders, PT grade was strongly associated with PT volume (beta = 1.8, 95% confidence interval [CI]: [1.0, 2.6], P < 0.001) and with AHI (beta = 13.5, 95% CI: [3.5, 23.6], P = 0.01); PT volume was not associated with AHI (beta = -0.2, 95% CI: [-2.2, 1.9], P = 0.89). CONCLUSION: In contrast to past studies, subjective PT grade (vs. objective PT volume) was more strongly associated with AHI. These data suggest the space that the tonsils occupy within the oropharyngeal airway, instead of their actual measured volume, may be more predictive of OSA severity in a cohort of U.S. adult patients. LEVEL OF EVIDENCE: 2c. Laryngoscope, 128:1002-1006, 2018.

The association between secondhand smoke and sleep-disordered breathing in children: a systematic review.

OBJECTIVE: To systematically review existing literature on the association between secondhand smoke and sleep-disordered breathing in children. DATA SOURCES: PubMed, Embase, Cochrane CENTRAL, Web of Science, and Scopus. REVIEW METHODS: Inclusion criteria included English-language papers containing original human data, with seven or more subjects and age <18 years. Data were systematically collected on study design, patient demographics, clinical characteristics/outcomes, and level of evidence. Two investigators independently reviewed all manuscripts. RESULTS: The initial search yielded 72 abstracts; 18 articles were ultimately included with a total study population of 47,462 patients. Fifteen (83%) articles found a statistically significant association between secondhand smoke and sleep-disordered breathing. All were case-control studies. Quality of articles based on the Newcastle-Ottawa scale averaged 5.8/9 stars. Secondhand smoke was characterized by serum cotinine testing in only two (11%) studies. Sleep-disordered breathing was quantified by polysomnography in only four (22%) of the studies and only one (6%) classified subject using polysomnography exclusively. Habitual snoring was the most common form of sleep-disordered breathing studied in 14/18 (78%) studies, whereas obstructive sleep apnea was reported in one (6%) study and sleep-related hypoxia in another (6%) study. CONCLUSIONS: Although the majority of studies included in this review found a significant association between secondhand smoke and sleep-disordered breathing, all of them were evidence level 3b, for an overall grade of B (Oxford Centre for Evidence-based Medicine). Further higher-quality studies should be performed in the future to better evaluate the relationship between second- smoke and sleep-disordered breathing in children.

Utility of BRAF mutation detection in fine-needle aspiration biopsy samples read as "suspicious for papillary thyroid carcinoma".

BACKGROUND: The purpose of this study was to evaluate the diagnostic utility of BRAF mutation testing on thyroid nodules "suspicious for papillary thyroid carcinoma" (PTC) cytology. METHODS: A chart review of patients with fine-needle aspiration (FNA) results "suspicious for PTC" with subsequent thyroidectomy was performed. Corresponding archived FNA slides underwent BRAF mutation testing. RESULTS: Sixty-six patients with FNA "suspicious for PTC" underwent thyroidectomy. Forty-two (63.6%) had PTC diagnosed on final histopathology, whereas 21 (31.8%) had benign findings. Thirty-five patients (83%) with histologically proven PTC underwent total thyroidectomy, whereas 7 (17%) underwent hemithyroidectomy. BRAF mutation was detected in 17 of 49 samples (34.6%) available for testing and had 45.5% sensitivity, 87.5% specificity, 88.2% positive predictive value (PPV), and 43.8% negative predictive value (NPV) for diagnosing PTC. Two of 4 patients (50%) who underwent hemithyroidectomy with subsequent completion thyroidectomy had mutated BRAF detected. CONCLUSION: BRAF testing is a useful adjunct to improve PPV for patients with "suspicious for PTC" cytology.

The relationship between chronic lymphocytic thyroiditis and central neck lymph node metastasis in North American patients with papillary thyroid carcinoma.

BACKGROUND: Several studies have reported that concurrent chronic lymphocytic thyroiditis (CLT) with papillary thyroid carcinoma (PTC) is associated with improved prognosis of the PTC, including decreased lymph node metastasis. We sought to assess the incidence of central nodal metastasis (CNM) in patients with PTC and concurrent CLT. METHODS: We studied 495 consecutive patients who underwent thyroidectomy with nodal excision for PTC. Pathology reports identified the presence of CLT and the extent of CNM. RESULTS: There were 226 patients (46%) with CLT and 220 (44%) with CNM. Patients with CLT were more often female (88% vs. 71%; P < .001) and had a younger median age (43 vs. 47 years; P = .03), a lesser incidence of CNM (35% vs. 52.4%; P < .001), and a greater incidence of pT1a (40% vs. 25%; P < .001) and pT1b (38% vs. 29%; P < .001) tumors. Multivariate analysis showed that the presence of CLT was associated with a 39% decreased odds of CNM after adjusting for age, gender, tumor size, PTC histopathologic subtype, and presence of lymphovascular invasion (odds ratio, 0.61; 95% confidence interval, 0.38-0.99; P = .046). Predicted probability modeling showed that all females with CLT and no suspicious nodal findings on ultrasonography had a 9-11% risk of CNM with pT1a tumors. CONCLUSION: Female patients of all ages with CLT and small PTCs have the least incidence of CNM.

Galleria mellonella as a model system to study Acinetobacter baumannii pathogenesis and therapeutics.

Nonmammalian model systems of infection such as Galleria mellonella (caterpillars of the greater wax moth) have significant logistical and ethical advantages over mammalian models. In this study, we utilize G. mellonella caterpillars to study host-pathogen interactions with the gram-negative organism Acinetobacter baumannii and determine the utility of this infection model to study antibacterial efficacy. After infecting G. mellonella caterpillars with a reference A. baumannii strain, we observed that the rate of G. mellonella killing was dependent on the infection inoculum and the incubation temperature postinfection, with greater killing at 37 degrees C than at 30 degrees C (P = 0.01). A. baumannii strains caused greater killing than the less-pathogenic species Acinetobacter baylyi and Acinetobacter lwoffii (P < 0.001). Community-acquired A. baumannii caused greater killing than a reference hospital-acquired strain (P < 0.01). Reduced levels of production of the quorum-sensing molecule 3-hydroxy-C(12)-homoserine lactone caused no change in A. baumannii virulence against G. mellonella. Treatment of a lethal A. baumannii infection with antibiotics that had in vitro activity against the infecting A. baumannii strain significantly prolonged the survival of G. mellonella caterpillars compared with treatment with antibiotics to which the bacteria were resistant. G. mellonella is a relatively simple, nonmammalian model system that can be used to facilitate the in vivo study of host-pathogen interactions in A. baumannii and the efficacy of antibacterial agents.