Pediatric Obstructive Sleep Apnea: Where Do We Stand?
In conclusion, we have made progress in our understanding of pediatric OSA, and we can even recognize factors leading to its development or worsening. However, pediatricians and pediatric subspecialists are often unaware of the advances and the remedies available.
PMID: 28738322 [PubMed - in process] (Source: Advances in Oto-Rhino-Laryngology)
Source: Advances in Oto-Rhino-Laryngology - July 26, 2017 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Updated Concepts on Treatment Outcomes for Obstructive Sleep Apnea.
Authors: Certal V, Capasso R
Abstract
Obstructive sleep apnea is a highly prevalent and poorly understood condition that not only leads to significant individual patient health damage, but carries a large societal cost secondary to excessive healthcare utilization, motor-vehicle accidents, and work absenteeism. While a significant fund of knowledge about its damaging effects on the cardiovascular system and neural pathways has been gathered over the past few decades, the translation to direct patient care still presents numerous challenges. With the exception of clear issues such as socially unacceptable s...
Source: Advances in Oto-Rhino-Laryngology - July 26, 2017 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Future Perspectives in Sleep Medicine.
Authors: Huon LA, Guilleminault C
Abstract
"Sleep Medicine" is now a specialty in its own right. Currently, there is increasing recognition of the very negative impact sleep disorders have on learning, education, safety, and quality of life. Technological advances will help us to break down diagnoses (e.g., narcolepsy has now been subdivided into types 1 and 2, depending upon the hypocretin levels in the spinal fluid) and to discover relationships to other bodily systems (e.g., type 1 narcolepsy potentially being an autoimmune disorder). The modern lifestyle of many, as characterized by a shortening of sle...
Source: Advances in Oto-Rhino-Laryngology - July 26, 2017 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Updated Hypopharyngeal Surgery for Sleep Apnea.
Authors: Woodson BT
Abstract
The failure of traditional upper airway surgery such as uvulopalatopharyngoplasty has been attributed to lower airway obstruction related to base of tongue collapse. Multiple procedures, including glossectomy, tongue base radiofrequency, genioglossus advancement, and tongue suspension techniques, have been advocated to improve success rates. No consensus exists on which subsets of patients are best treated by individual approaches and direct comparative data are lacking. The selection of procedures must be based on individual patient needs and the relative potential benefits an...
Source: Advances in Oto-Rhino-Laryngology - July 26, 2017 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
The History of Sleep Surgery.
Authors: Yaremchuk K, Garcia-Rodriguez L
Abstract
Snoring and the subsequent diagnosis of obstructive sleep apnea (OSA) was a life-threatening medical condition with no available treatment until the late 20th century. An early description of OSA was provided by Charles Dickens in his 1836 novel Pickwick Papers with the description of a "fat boy" who was thought to be lazy and always falling asleep but likely displayed hypersomnolence from OSA. It was not until 1976 that Ikematsu first described uvulopalatopharyngoplasty (UPPP) as an alternative surgical treatment of "snoring," with a reported cure rate of ...
Source: Advances in Oto-Rhino-Laryngology - July 26, 2017 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Novel Positional Devices for the Treatment of Positional Obstructive Sleep Apnea, and How This Relates to Sleep Surgery.
Authors: Revesloot MJL, Benoist L, van Maanen P, de Vries N
Abstract
If untreated, obstructive sleep apnea (OSA) develops as a gradual progressive disease. In the early stage of the disease most patients with OSA are positional. The archetypical patient might progress from simple positional snoring via positional early-stage mild disease to less positional moderate and finally nonpositional severe OSA. At first, the apnea-hypopnea index (AHI) is high only in the supine position, and later is high in all sleeping positions. The phenomenon is reversible. After partial effective treatment, patients with sever...
Source: Advances in Oto-Rhino-Laryngology - July 26, 2017 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
A Succinct History of Sleep Medicine.
Authors: Huon LA, Guilleminault C
Abstract
Although sleep and sleep disorders have been studied for centuries, it was the development of sophisticated tools to monitor eye movements, brain waves, and muscle tone in the mid-20th century that led to modern sleep research. These tools allowed neuroscientists to distinguish between different "states" or "phases" of sleep, and to relate these findings to sleep disorders. This review chronicles the groundbreaking work of the pioneers in this field, and the impact their findings have had on patients today.
PMID: 28738342 [PubMed - in process] (Source: Adv...
Source: Advances in Oto-Rhino-Laryngology - July 26, 2017 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Future Perspectives in Sleep Surgery.
Authors: Friedman M, Salapatas AM, Bonzelaar LB
Abstract
Over the past few decades there has been a significant increase in research focusing on the pathophysiology, diagnosis, and treatment of sleep apnea. However, there is still a long way to go in creating standard evidence-based medical practice for the diagnosis, evaluation, and treatment of sleep apnea patients. Current and future directions of sleep surgery and other treatments are discussed here.
PMID: 28738352 [PubMed - in process] (Source: Advances in Oto-Rhino-Laryngology)
Source: Advances in Oto-Rhino-Laryngology - July 26, 2017 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Innovative Surgery for Obstructive Sleep Apnea: Nerve Stimulator.
This article gives a comprehensive overview of current and upcoming hypoglossal nerve stimulation systems (Inspire, ImThera, and Nyxoah), the specific advantages of this approach, the selection criteria and screening process, relevant clinical data, and a description of the different implantation procedures. Upper airway stimulation and hypoglossal nerve stimulation appears to be a long-term, low-morbidity treatment for moderate-to-severe OSA patients suffering from CPAP incompliance.
PMID: 28738358 [PubMed - in process] (Source: Advances in Oto-Rhino-Laryngology)
Source: Advances in Oto-Rhino-Laryngology - July 26, 2017 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Advances in the Diagnosis of Obstructive Sleep Apnea: Drug-Induced Sleep Endoscopy.
Authors: Revesloot MJL, Benoist L, van Maanen P, Kezirian EJ, de Vries N
Abstract
Drug-induced sleep endoscopy was introduced in 1991 and has recently evolved into a pivotal instrument for patients in whom obstructive sleep apnea surgery is considered. Here, we discuss the indications, contraindications, technique, anesthesia, scoring systems, validity, and insights of the literature.
PMID: 28738362 [PubMed - in process] (Source: Advances in Oto-Rhino-Laryngology)
Source: Advances in Oto-Rhino-Laryngology - July 26, 2017 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Advances in Box Surgery for Obstructive Sleep Apnea: Genioglossus Advancement, Hyoid Suspension, and Maxillomandibular Advancement.
Authors: Goh YH, Tan W, Abdullah VJ, Kim SW
Abstract
Box surgery for obstructive sleep apnea (OSA) patients consists of mandibular surgery, including genioglossus advancement, hyoid suspension, and maxillomandibular advancement, as an airway reconstruction. This surgery was developed in the early 1980s. Thereafter, techniques were modified in each surgery for the enhancement of outcome and prevention of complications. However, the indication for surgery remains poorly defined due to the dynamicity of the upper airway, variability of the phenotype in OSA patients, and absence of a representative method for ...
Source: Advances in Oto-Rhino-Laryngology - July 26, 2017 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Updated Minimally Invasive Surgery for Sleep-Related Breathing Disorders.
Authors: Kotecha B
Abstract
Sleep-related breathing disorders (SRBD) consist of a variety of clinical entities, ranging from primary snoring to severe obstructive sleep apnoea at the opposite extreme. Although it has no official definition, minimally invasive surgery infers surgery where the procedure is clinically less aggressive and may involve a much smaller incision or none at all. It also implies that such procedures may result in a quicker recovery and reduced morbidity, and that they are often conducted under local anaesthesia as day cases. Minimally invasive surgery in SRBD may be performed on its ...
Source: Advances in Oto-Rhino-Laryngology - July 26, 2017 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Robotic Obstructive Sleep Apnea Surgery.
Authors: Toh ST, Hsu PP
Abstract
Since the first report of the use of the da Vinci robotic system (Intuitive Surgical, Sunnyvale, CA, USA) in transoral robotic tongue base reduction for obstructive sleep apnea (OSA) was published in 2010, this surgical tool and technique has been used worldwide for the resection of tongue base tissue in the multilevel surgical treatment of OSA. The combined knowledge of the published literature on its use has enlightened sleep surgeons worldwide on this new yet evolving surgical tool. Here we will discuss the use of the da Vinci robotic system in the treatment of OSA, the ...
Source: Advances in Oto-Rhino-Laryngology - July 26, 2017 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Advances in Oral Appliances for Obstructive Sleep Apnea.
Authors: Jacobowitz O
Abstract
Oral appliances that advance the mandible are widely used as alternatives to positive airway pressure (PAP) devices or as primary therapy for obstructive sleep apnea (OSA) in adults. Although PAP is more efficacious at lowering the polysomnographic indices of OSA, the clinical effectiveness of PAP and oral appliances is similar, and patients are more likely to adhere to oral appliance therapy than to PAP treatment. Clinical examination is used to determine the candidacy of oral appliances and to select a particular appliance for a given patient. Endoscopic examination of the ...
Source: Advances in Oto-Rhino-Laryngology - July 26, 2017 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Multilevel Obstructive Sleep Apnea Surgery.
Authors: Lin HC, Weaver EM, Lin HS, Friedman M
Abstract
Continuous positive airway pressure (CPAP) is the primary treatment of obstructive sleep apnea/hypopnea syndrome (OSA). Most sleep physicians are in agreement that a certain number of OSA patients cannot or will not use CPAP. Although other conservative therapies, such as oral appliance, sleep hygiene, and sleep positioning, may help some of these patients, there are many who fail all conservative treatments. As sleep surgeons, we have the responsibility to screen patients for both symptoms and signs of OSA. As experts of upper airway diseases, we oft...
Source: Advances in Oto-Rhino-Laryngology - July 26, 2017 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
