Laryngeal Botulinum Toxin Injection: Can It Be a Cause of Obstructive Sleep Apnea as an Adverse Effect?

Spasmodic dysphonia is a chronic voice disorder that is characterized by involuntary spasms of the laryngeal muscles during speech production. Botulinum toxin injection into to the laryngeal muscles is the most common and effective treatment of choice for symptoms of spasmodic dysphonia. We present a 44-year-old man with adductor spasmodic dysphonia who was diagnosed as having upper airway obstruction in a polysomnographic examination during sleep after a botulinum toxin injection.

Evaluation of the Impact of Body Position on Primary Central Sleep Apnea Syndrome.

OBJECTIVE: To evaluate the impact of the body position on primary central sleep apnea syndrome. METHODS: Fifty-five subjects diagnosed with central sleep apnea (CSA) through polysomnographic examinations were prospectively enrolled in the study. All patients underwent cardiologic and neurologic examinations. Primary positional central sleep apnea (PCSA) was determined when the supine Apnea-Hypopnea Index (AHI) was greater than two times the non-supine AHI. The primary PCSA and non-PCSA groups were compared in terms of demographic characteristics, sleep parameters, and treatment approaches. RESULTS: Overall, 39 subjects diagnosed with primary CSA were included in the study; 61.5% of the subjects had primary PCSA. There were no differences between the primary PCSA and non-PCSA groups regarding age, sex, body mass index (BMI), co-morbidities, and history of septoplasty. In terms of polysomnography parameters, AHI (P=.001), oxygen desaturation index (P=.002), the time spent under 88% saturation during sleep (P=.003), number of obstructive apnea (P=.011), mixed apnea (P=.009), and central apnea (P=.007) was lower in the primary PCSA group than in the non-PCSA group. Twenty-nine percent of the patients in the primary PCSA group were recommended position treatment and 71% were recommended positive airway pressure (PAP) therapy; all patients in the non-PCSA group were recommended PAP therapy. CONCLUSIONS: Our results demonstrated that the rate of primary PCSA was high (61.5%) and primary PCSA was associated with milder disease severity compared with non-PCSA. The classification of patients with primary CSA regarding positional dependency may be helpful in terms of developing clinical approaches and treatment recommendations.

Evaluation of the Impact of Body Position on Primary Central Sleep Apnea Syndrome / Evaluación del impacto de la posición corporal en el síndrome de apnea central del sueño primaria

Objective: To evaluate the impact of the body position on primary central sleep apnea syndrome.Methods: Fifty-five subjects diagnosed with central sleep apnea (CSA) through polysomnographic examinations were prospectively enrolled in the study. All patients underwent cardiologic and neurologic examinations. Primary positional central sleep apnea (PCSA) was determined when the supine Apnea–Hypopnea Index (AHI) was greater than two times the non-supine AHI. The primary PCSA and non-PCSA groups were compared in terms of demographic characteristics, sleep parameters, and treatment approaches.Results: Overall, 39 subjects diagnosed with primary CSA were included in the study; 61.5% of the subjects had primary PCSA. There were no differences between the primary PCSA and non-PCSA groups regarding age, sex, body mass index (BMI), co-morbidities, and history of septoplasty. In terms of polysomnography parameters, AHI (P=.001), oxygen desaturation index (P=.002), the time spent under 88% saturation during sleep (P=.003), number of obstructive apnea (P=.011), mixed apnea (P=.009), and central apnea (P=.007) was lower in the primary PCSA group than in the non-PCSA group. Twenty-nine percent of the patients in the primary PCSA group were recommended position treatment and 71% were recommended positive airway pressure (PAP) therapy; all patients in the non-PCSA group were recommended PAP therapy. (AU)

Objetivo: Evaluar el impacto de la posición del cuerpo en el síndrome de apnea central del sueño primaria.Métodos: En el estudio se incluyeron prospectivamente 55 sujetos con diagnóstico de apnea central del sueño (ACS) a través de sus estudios polisomnográficos. Todos los pacientes fueron sometidos a exámenes cardiológicos y neurológicos. La apnea central del sueño posicional (ACSP) se estableció cuando el índice de apnea-hipopnea (IAH) en posición supina fue más de dos veces mayor que el IAH en posición no supina. Se compararon los grupos de pacientes con ACSP primaria y sin ACSP en función de las características demográficas, los parámetros del sueño y los enfoques de tratamiento.Resultados: En total, se incluyeron en el estudio 39 sujetos con diagnóstico de ACS primaria. El 61,5% de los sujetos presentaban ACSP primaria. No hubo diferencias entre los grupos de ACSP primaria y sin ACSP con respecto a la edad, el sexo, el índice de masa corporal (IMC), las comorbilidades y los antecedentes de septoplastia. En cuanto a los parámetros de polisomnografía, el IAH (p=0,001), el índice de desaturación de oxígeno (p=0,002), el tiempo transcurrido con una saturación por debajo del 88% durante el sueño (p=0,003) y el número de apneas obstructivas (p=0,011), de apneas mixtas (p=0,009) y de apneas centrales (p=0,007) fueron menores en el grupo con ACSP primaria que en el grupo sin ACSP. Al 29% de los pacientes en el grupo de ACSP primaria se les recomendó tratamiento posicional y al 71% se les recomendó tratamiento de presión positiva de la vía aérea (PAP); a todos los pacientes del grupo sin ACSP se les aconsejó tratamiento PAP. (AU)

Which Screening Questionnaire is Best for Predicting Obstructive Sleep Apnea in the Sleep Clinic Population Considering Age, Gender, and Comorbidities?

OBJECTIVE: The purpose of this study was to evaluate the predictive power of the screening questionnaires including Epworth Sleepiness Scale (ESS), Berlin questionnaire (BQ) and STOP-Bang questionnaire (SBQ) to identify the high-risk patients for OSA in a sleep clinic setting considering age, gender and comorbidities. MATERIAL AND METHODS: 1003 patients who admitted to our sleep center with the preliminary diagnosis of OSA between June 2016-May 2018 were included in the study. All patients underwent in-lab polysomnographic examination and filled out ESS, Berlin and STOP-Bang questionnaires. Predictive parameters for each screening questionnaires were calculated. RESULTS: For apnea-hypopnea index (AHI) ≥5/h, the sensitivity and the specificity of the EES, BQ and SBQ were 50.6%, 89.8%, 97.9% and 56.6%, 27.3%, 16.2% respectively. The STOP-Bang questionnaire had the highest sensitivity in both males and females (99.1%, 94.8% respectively) and in the different age groups (97.3% for ≥45 age-group, 99.2% for ≥65 age-group). In the groups of patients with hypertension, diabetes mellitus, coronary artery disease, chronic obstructive pulmonary disease and asthma, the sensitivity of the STOP-Bang questionnaire was 99.5%, 100%, 99.5%, 100%, 97.4%, respectively. CONCLUSION: The STOP-Bang questionnaire had the highest sensitivity for detecting high-risk patients for OSA in a sleep clinic setting. STOP-Bang questionnaire was superior to the Berlin questionnaire and ESS in the different groups of age, gender, and comorbidities. Considering the close relationship between OSA and comorbidities, it is critical to screen patients in terms of OSA in outpatient clinics of internal medicine, cardiology, and chest disease departments. The STOP-Bang questionnaire, with its high sensitivity, may be useful for screening OSA. However, the low specificity should be improved in the questionnaire.