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Objective: Upper airway surgery is a common therapeutic approach recommended for patients with obstructive sleep apnea (OSA) to decrease disease burden. We aimed to evaluate the effect of perioperative antibiotic prescription on complication rates. Study Design: Retrospective cohort (national database). Setting: Tertiary referral center. Methods: This is a retrospective study of a large national health care insurance database (Truven MarketScan) from 2007 to 2015. Subjects diagnosed with OSA who had uvulopalatopharyngoplasty (UPPP) were included and stratified in single versus multilevel surgery. Other variables included smoking, age, sex, antibiotic prescription, and comorbidities based on the Elixhauser index. Evaluated outcomes were postoperative bleeding, intubation, pneumonia, superficial surgical site infection, tracheostomy, and hospital readmission. A multivariate regression model was created to assess each complication. Results: A total of 5,798,528 subjects received a diagnosis of OSA, of which 39,916 were >18 years old and underwent UPPP, either alone or with additional procedures. The mean age was 43 years, and 73.4% were male. Antibiotic prescription was associated with less bleeding in UPPP alone, UPPP with nasal surgery, and UPPP with nasal and tongue surgery (P <.001, P <.001, and P =.006, respectively). It was also associated with a lower prevalence of surgical site infection, pneumonia, tracheostomy, intubation, and hospital readmission (P <.001). On a multivariate model, antibiotic prescription was significantly associated with a decreased rate of complications. Conclusions: Although former studies recommended against the use of antibiotics after tonsillectomy, our results suggest that antibiotic prescription after UPPP for OSA was associated with less bleeding, surgical site infection, pneumonia, intubation, tracheostomy, and hospital readmission 30 days postoperatively. [ABSTRACT FROM AUTHOR]

Introduction: Pharyngoplasty techniques for the treatment of obstructive sleep apnea syndrome (OSAS) have evolved, which improved the understanding of the anatomy, patient selection, and adoption of functional approaches. Aim: To analyze long-term results of pharyngoplasty in OSAS patients. Material and methods: Between 2007 and 2021, a total of 234 adult patients with OSAS who had previously failed positive airway pressure (PAP) therapy underwent sleep surgery. Of this group, 75 patients met the criteria of a minimum 5-year follow-up. To date, 25 patients completed the follow-up study protocol, including the medical history, visual analog scale (VAS) for snoring loudness, body mass index (BMI), endoscopy of the upper airways, type III sleep study, and standardized questionnaires including Epworth Sleepiness Scale (ESS) and EQ-5D-5L Euro – Quality of Life Questionnaire. Results: The average period of follow-up was 96.80 ± 30.20 months. The mean age of participants was 54.6 ± 14.02 and the mean BMI 30.28 ± 2.74. Patients underwent uvulopalatopharyngoplasty (n = 21) and expansion sphincterpharyngoplasty (n = 4) between 2008–2015. A long-term improvement in sleep parameters was observed for the mean AHI (29.84 ± 20.06 before and 19.45 ± 18.53 after surgery, p = 0.0294), and the median VAS (8.13 before and 3.78 after surgery), mean oxygen saturation during sleep 94,5% (IQR 93.0–95.25), and the median ESS score was 6.17 ± 4.57. The majority of patients reported subjective long-term improvement in sleep quality and a reduction of snoring. Conclusions: In OSAS patients who failed PAP therapy, pharyngoplasty may provide a long-term improvement in upper airway obstruction during sleep. [ABSTRACT FROM AUTHOR]

Sleep surgery is part of a continuum of care for obstructive sleep apnea (OSA) that involves medical, pharmacologic, and behavioral therapy. Upper airway surgery for OSA can significantly improve stability by way of modulating the critical negative closing pressure. This is the same mechanism of action as positive airway pressure or oral appliance therapy. The updated surgical algorithm in this review adds precision in three areas: patient selection, identification of previously unaddressed anatomic phenotypes with associated treatment modality, and improved techniques of previously established procedures. While the original Riley and Powell phase 1 and 2 approach to sleep surgery has focused on individual surgical success rate, this algorithm strives for an overall treatment success with multi-modal and patient-centric treatments.

There are many ways to categorize surgery for obstructive sleep apnea (OSA), one of which is to distinguish between intrapharyngeal and extrapharyngeal procedures. While the general otolaryngologist treating OSA is familiar with intrapharyngeal procedures, such as uvulopalatopharyngoplasty and tongue base reduction, extrapharyngeal sleep operations such as maxillomandibular advancement (MMA) and upper airway stimulation (UAS) have evolved rapidly in the recent decade and deserve a dedicated review. MMA and UAS have both shown predictable high success rates with low morbidity. Each approach has unique strengths and limitations, and for the most complex of OSA patients, the two in combination complement each other. Extrapharyngeal airway operations are critical for achieving favorable outcomes for sleep surgeons.

PurposeTo determine whether treatment with uvulopalatopharyngoplasty (UPPP) or continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea (OSA) prevents hypertension, compared to those not receiving any treatment.MethodsA retrospective cohort study was conducted among 413 patients with OSA (age ≥ 35 years) at the Shuang Ho Hospital between 2009 and 2016. The patients were divided into three groups: UPPP, CPAP, and non-treatment groups. Data about the personal characteristics, history of comorbidities, and polysomnography (PSG) reports were collected at baseline. A Cox model with inverse probability of treatment weighting was used to adjust for confounders and baseline diversity.ResultsAfter multivariate adjustment and weighting for incident hypertension, patients in both the CPAP and UPPP groups showed a significant preventive effect on hypertension than in the non-treatment group. Moreover, patients in the CPAP group had lower event rates than those in the UPPP group.ConclusionUPPP can prevent the development of new-onset hypertension in patients with OSA. CPAP had a better preventive effect than UPPP. UPPP might be a good alternative for reducing the risk of the onset of hypertension when compliance to CPAP is poor.

Objective: Since 2011, otolaryngologists aiming to become certified in sleep medicine have had to complete an ACGME accredited sleep medicine fellowship. In addition to standard sleep medicine and sleep surgery fellowships, several institutions have developed hybrid ACGME sleep medicine programs that incorporate sleep surgery training. Our primary aims were to understand the balance between sleep medicine and surgical training requirements and the surgical volume of recent graduates across the three pathways. Our secondary aim was to assess their employment post-graduation. An improved understanding of the current state of sleep surgeon training could better inform both applicants and programs and be used to guide fellowship curriculum development., Methods: Between 2017 and 2023, we identified 26 surgeons who completed a sleep focused fellowship. An anonymous survey was developed and emailed to them. The survey assessed clinic and operating balance, procedures completed during fellowship, and comfort with these procedures as attendings. Finally, the survey assessed the job prospects of graduates. Data were analyzed with Prism 10., Results: There were 19 respondents with 52.6% completing a hybrid fellowship, 21.3% completing a sleep medicine fellowship, and 31.6% completing a sleep surgery fellowship. Approximately 84.8% completed ACGME accredited otolaryngology training prior to fellowship. The three most common surgeries were hypoglossal nerve stimulators, pharyngoplasty, and nasal surgeries. Respondents on average received 2.4 job offers, 55% returned to their residency institution, and 89.5% were in academics., Conclusion: Our survey demonstrates a wide variability in sleep-focused fellowships for surgeons, but the employment market for these trainees is robust., Level of Evidence: N/A Laryngoscope, 2024., (© 2024 The Author(s). The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc.)

Study Objectives: The purpose of this systematic review is to evaluate the modifiable risk factors associated with OSA and analyze extant publications solely focused on prevention of the disease., Methods: Studies focused on prevention strategies for OSA and modifiable risk factors were eligible for inclusion. A detailed individual search strategy for each of the following bibliographic databases was developed: Cochrane, EMBASE, MEDLINE, PubMed and LILACS. The references cited in these articles were also crosschecked and a partial grey literature search was undertaken using Google Scholar. The methodology of selected studies was evaluated using the 14-item Quality Assessment Tool for Diagnostic Accuracy Studies., Results: Search resulted in 720 publications examining risk factors and prevention of OSA, as well as lifestyle modifications. Of these, a thorough assessment of the abstracts and content of each of these manuscripts led to the rejection of all but four papers, the latter being included in this systematic review. In contrast, a search regarding 'Therapeutics' showed that 23,674 articles on OSA were published, clearly illustrating the imbalance between the efforts in prevention and those focused on therapeutics., Conclusions: Notwithstanding the importance and benefits of technological advances in medicine, consideration of the needs of people with OSA and its consequences prompts advocacy for the prevention of the disease. Thus, despite the economic interests that focus only on diagnosis and treatment, strategies preferentially aimed at overall avoidance of OSA emerge as a major priority. Thus, public and healthcare provider education, multidimensional prevention, and early diagnosis of OSA should be encouraged worldwide., (© The Author(s) 2024. Published by Oxford University Press on behalf of Sleep Research Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Objective: To use pharyngeal pressure recordings to distinguish different upper airway collapse patterns in obstructive sleep apnea (OSA) patients, and to assess whether these pressure recordings correlate with candidacy assessment for hypoglossal nerve stimulator (HGNS) implantation., Study Design: Prospective case series., Setting: Single tertiary-quaternary care academic center., Methods: Subjects with OSA prospectively underwent simultaneous drug-induced sleep endoscopy (DISE) and transnasal pharyngeal pressure recording with a pressure-transducing catheter. Pressure was recorded in the nasopharynx and oropharynx, and endoscopic collapse patterns were classified based on site, extent, and direction of collapse. Pressure recordings were classified categorically by waveform shape as well as numerically by inspiratory and expiratory amplitudes and slopes. Waveform shape, amplitude, and slope were then compared with the endoscopic findings., Results: Twenty-five subjects with OSA were included. Nasopharyngeal waveform shape was associated with the extent of collapse at the level of the palate ( P  = .001). Oropharyngeal waveform shape was associated with anatomical site of collapse ( P  < .001) and direction of collapse ( P  = .019) below the level of the palate. Pressure amplitudes and slopes were also associated with the extent of collapse at various sites. Waveform shape was also associated with favorable collapse pattern on endoscopy for HGNS implantation ( P  = .043), as well as surgical candidacy for HGNS ( P  = .004)., Conclusion: Characteristic pharyngeal pressure waveforms are associated with different airway collapse patterns. Pharyngeal pressure is a promising adjunct to DISE in the sleep surgery candidacy evaluation., Competing Interests: The authors declare that there is no conflict of interest., (© 2024 The Author(s). OTO Open published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Purpose: No study to date has described the overall landscape of sleep disorders management and training in otolaryngology departments of different countries. The aim of our study was to investigate and compare settings, diagnostic and therapeutic approaches and training programmes. Methods: An international online survey was developed with the collaboration of the YO-IFOS (Young Otolaryngologists-International Federation of Otorhinolaryngological Societies) to assess the current practice of otolaryngologists in the management of sleep disorders. The survey also included a session dedicated to training. Results: A total of 126 otolaryngologists completed the survey. The larger part of responses was collected from Central/South America and Europe. The majority of responders from South/Central America (97%) declared to be certified as sleep specialist while 49% of Europeans stated the opposite. Of responders 83% perform a drug-induced sleep endoscopy (DISE) before planning a possible surgical intervention. Soft palate and base of tongue interventions were the most common procedure, respectively performed in 94% and 79% of the cases. Residents were allowed to perform soft palate surgery in 77% of the cases. Upper airway stimulation (26% vs 10%), trans-oral robotic surgery (36% vs 11%) and radiofrequency of the base of the tongue (58% vs 25%) were preferred more frequently by European responders. The highest caseloads of soft palate surgery and bi-maxillary advancement were registered in the academic institutions. Conclusion: Significant concordance and few interesting divergences in diagnosis and treatment of sleep disorders were observed between nationalities and types of institution. Economic resources might have played a significant role in the therapeutic choice. Trainees' lack of exposure to certain interventions and to a sufficient caseload appeared to be the main burden to overcome. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: To provide the ADHERE registry Upper Airway Stimulation (UAS) outcomes update, including analyses grouped by body mass index (BMI) and therapy discomfort. Study Design: Prospective observational study. Methods: ADHERE captures UAS outcomes including apnea‐hypopnea index (AHI), Epworth sleepiness scale (ESS), therapy usage, patient satisfaction, clinician assessment, and safety over a 1‐year period. BMI ≤32 kg/m2 (BMI32) and 32 < BMI ≤35 kg/m2 (BMI35) group outcomes were examined. Results: One thousand eight hundred forty‐nine patients enrolled in ADHERE, 1,019 reached final visit, 843 completed the visit. Significant changes in AHI (−20.9, P <.0001) and ESS (− 4.4, P <.0001) were demonstrated. Mean therapy usage was 5.6 ± 2.2 hr/day. Significant therapy use difference was present in patients with reported discomfort versus no discomfort (4.9 ± 2.5 vs. 5.7 ± 2.1 hr/day, P =.01). Patients with discomfort had higher final visit mean AHI versus without discomfort (18.9 ± 18.5 vs. 13.5 ± 13.7 events/hr, P =.01). Changes in AHI and ESS were not significantly different. Serious adverse events reported in 2.3% of patients. Device revision rate was 1.9%. Surgical success was less likely in BMI35 versus BMI32 patients (59.8% vs. 72.2%, P =.02). There was a significant therapy use difference: 5.8 ± 2.0 hr/day in BMI32 versus 5.2 ± 2.2 hr/day in BMI35 (P =.028). Conclusions: Data from ADHERE demonstrate high efficacy rates for UAS. Although surgical response rate differs between BMI32 and BMI35 patient groups, the AHI and ESS reduction is similar. Discomfort affects therapy adherence and efficacy. Thus, proper therapy settings adjustment to ensure comfort is imperative to improve outcomes. Level of Evidence: 4 Laryngoscope, 131:2616–2624, 2021 [ABSTRACT FROM AUTHOR]

Objective: Sleep medicine is a multidisciplinary field that includes otolaryngology. After 2011, sleep medicine board eligibility required completion of a dedicated sleep medicine fellowship. The objective of our study is to describe the characteristics and geographic distribution of the dual board‐certified sleep otolaryngology workforce and to assess the impact of the 2011 change. Methods: A cross‐sectional analysis of sleep‐certified otolaryngologists registered with the American Board of Otolaryngology‐Head and Neck Surgery in 2019 was performed to characterize the sleep otolaryngology workforce. County and regional analysis of provider density was conducted by comparing provider characteristics with county‐level data from the United States Census Bureau. Results: There were 275 active dual board‐certified sleep otolaryngologists, or approximately 1 for every 1.12 million Americans. 77.8% were in private practice and 2.9% had American Society of Pediatric Otolaryngology membership. Eighty‐eight percent were male, with females more likely than males to be in an academic setting (36.4% for females compared to 20.2% for males; P =.045). The South Atlantic and South Central regions had the highest number of sleep board‐certified otolaryngologists per capita. Before 2011, an average of 75.7 otolaryngologists took the sleep board exam per 2‐year cycle, compared to 14.3 otolaryngologists after 2011 (P =.029). Conclusion: There are few dual board‐certified sleep otolaryngologists across the country, which may affect care for patients with sleep‐disordered breathing. Increased resident exposure and otolaryngology training in sleep medicine can strengthen the otolaryngology contribution to the multidisciplinary care of these patients. Level of Evidence: 4 Laryngoscope, 131:E2712–E2717, 2021 [ABSTRACT FROM AUTHOR]

Objectives: To determine the impact of adenotonsillectomy for treatment of severe obstructive sleep apnea (OSA) in children without comorbidities.Methods: A systematic review was performed to identify studies regarding adenotonsillectomy for treatment of children with severe sleep apnea. Polysomnographic parameters were considered as metric of cure and the number of patients of persistent apnea was calculated. Quality of evidence was graded using OCEBM (Oxford Center for Evidence Based Medicine) and MINORS (Methodological Index for Nonrandomized Studies) scores.Results: The systematic review included nine studies. Five studies were prospective and four retrospectives. No one was controlled. The number of subjects with severe OSA included was 499 with a prevalence of male. The mean age varied from 4.3 to 8.2. The follow-up period ranges from 1 to 23 months. The criteria for considering severe OSA ranges from AHI or RDI ≥10 to ≥30. All the trials have found a statistically significant reduction of postoperative AHI or RDI values in patients who had undergone adenotonsillectomy for severe OSA. The AHI and RDI improving varied from 57.7% to 93.3%. All the studies documented persistent OSA after adenotonsillectomy. The number of residual OSA considering AHI≥5 varied from 30 to 55.5%, in case of AHI ≥1 from 60 to 90.6%.Conclusion: To the best of our knowledge, this is the first review regarding the effectiveness of adenotonsillectomy for severe OSA in otherwise healthy children. Adenotonsillectomy is partially effective in the treatment of severe OSA in children without comorbidities. However, it reduces the severity of OSA determining a significant reduction of polysomnographic parameters. These results suggest a clinical and polysomnographic follow-up after surgery in order to manage the residual mild and moderate OSA. [ABSTRACT FROM AUTHOR]

Objective: To determine if there is an association between authors' financial conflict of interest and published position on clinical use of hypoglossal nerve stimulation for obstructive sleep apnea. Study Design: Retrospective cross-sectional analysis. Setting: International roster of authors and articles analyzed. Methods: A Google Scholar search was performed for editorials and reviews citing the 2014 New England Journal of Medicine article on hypoglossal nerve stimulation for obstructive sleep apnea. Included articles were coded as favorable or neutral. Conflict of interest was recorded as declared by the authors in these articles and as independently searched in the Open Payments registry. Results: Sixteen articles from 45 independent authors were analyzed. Nine articles by authors were coded as favorable. Among authors of articles with favorable views, 16 (59%) had a financial conflict of interest with the manufacturer of the hypoglossal nerve stimulator device, as opposed to only 1 of 21 (5%) authors of neutral/unfavorable articles. When we included only authors to whom payments could be identified or excluded on Open Payments, 16 of 20 (80%; 95% CI, 62%-98%) authors of favorable articles had a financial conflict, while 1 of 10 (10%; 95% CI, 0%-29.6%) of neutral/unfavorable articles did (P =.004). Conclusion: Our study demonstrates an association between published position on hypoglossal nerve stimulator use and financial conflict with the device manufacturer. Several undeclared conflicts were also found, suggesting a role for independent search for conflicts during the review process. [ABSTRACT FROM AUTHOR]

Objective: An increasing number of facilities offer Upper Airway Stimulation (UAS) with varying levels of experience. The goal was to quantify whether a surgical learning curve exists in operative or sleep outcomes in UAS. Methods: International multi-center retrospective review of the ADHERE registry, a prospective international multi-center study collecting UAS outcomes. ADHERE registry centers with at least 20 implants and outcomes data through at least 6-month follow-up were reviewed. Cases were divided into two groups based on implant order (the first 10 or second 10 consecutive implants at a given site). Group differences were assessed using Mann-Whitney U-tests, Chi-squared tests, or Fisher's Exact tests, as appropriate. A Mann-Kendall trend test was used to detect if there was a monotonic trend in operative time. Sleep outcome equivalence between experience groups was assessed using the two one-sided tests approach. Results: Thirteen facilities met inclusion criteria, contributing 260 patients. Complication rates did not significantly differ between groups (P =.808). Operative time exhibited a significant downward trend (P <.001), with the median operative time dropping from 150 minutes for the first 10 implants to 134 minutes for the subsequent 10 implants. The decrease in AHI from baseline to 12-month follow-up was equivalent between the first and second ten (22.8 vs 21.2 events/hour, respectively, P <.001). Similarly, the first and second ten groups had equivalent ESS decreases at 6 months (2.0 vs 2.0, respectively, P <.001). ESS outcomes remained equivalent for those with data through 12-months. Conclusions: Across the centers' first 20 implants, an approximately 11% reduction operative time was identified, however, no learning curve effect was seen for 6-month or 12-month AHI or ESS over the first twenty implants. Ongoing monitoring through the ADHERE registry will help measure the impact of evolving provider and patient specific characteristics as the number of implant centers increases. [ABSTRACT FROM AUTHOR]

Objective: To compare patients with moderate-severe obstructive sleep apnea (OSA) undergoing traditional single and multilevel sleep surgery to those undergoing upper airway stimulation (UAS). Study Design: Case control study comparing retrospective cohort of patients undergoing traditional sleep surgery to patients undergoing UAS enrolled in the ADHERE registry. Setting: 8 multinational academic medical centers. Subjects and Methods: 233 patients undergoing prior single or multilevel traditional sleep surgery and meeting study inclusion criteria were compared to 465 patients from the ADHERE registry who underwent UAS. We compared preoperative and postoperative demographic, quality of life, and polysomnographic data. We also evaluated treatment response rates. Results: The pre and postoperative apnea hypopnea index (AHI) was 33.5 and 15 in the traditional sleep surgery group and 32 and 10 in the UAS group. The postoperative AHI in the UAS group was significantly lower. The pre and postoperative Epworth sleepiness scores (ESS) were 12 and 6 in both the traditional sleep surgery and UAS groups. Subgroup analysis evaluated those patients undergoing single level palate and multilevel palate and tongue base traditional sleep surgeries. The UAS group had a significantly lower postoperive AHI than both traditional sleep surgery subgroups. The UAS group had a higher percentage of patients reaching surgical success, defined as a postoperative AHI <20 with a 50% reduction from preoperative severity. Conclusion: UAS offers significantly better control of AHI severity than traditional sleep surgery. Quality life improvements were similar between groups. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Selective upper airway stimulation (sUAS) is a well‐established treatment option for obstructive sleep apnea (OSA). This study aimed to determine if there are benefits in performing a home sleep test (HST) to evaluate postoperative sUAS effectiveness after patient acclimatization compared to the generally used polysomnography (PSG) titration, as measured by long‐term follow‐up outcomes. Study Design: Retrospective comparative cohort analysis. Methods: We conducted an analysis of consecutive patients at our center who had completed a 6‐month follow‐up (month 6 [M6]) and recorded data from M6, month 12 (M12), and month 24 (M24). After device activation, we performed an HST with the patient's stimulation settings, and measured the apnea‐hypopnea index (AHI), Epworth Sleepiness Scale (ESS), and device usage. These values were compared to patients who had undergone PSG‐based device titration. Results: Baseline values of the initial 131 patients show high ESS and moderate OSA. At the 2‐month time point of the HST, nearly half of the patients (46.2%) reached an AHI ≤15/hr, and approximately a fifth (19.2%) reached <5/hr. The PSG and HST groups differed in median ESS at M24, but no other differences were observed for ESS at M6 and M12. Both groups showed similar AHI, oxygen desaturation, and usage hours per week. Conclusions: Adjusting therapy by using the HST technique after device activation and acclimatization has clinical and economic advantages. These advantages are contingent on several conditions being met when deviating from the standard device protocol, including precise communication with the referring sleep medicine physicians, especially their role in helping with long‐term follow‐up. Level of Evidence: 4 Laryngoscope, 131:E1375–E1379, 2021 [ABSTRACT FROM AUTHOR]

Purpose: To determine the factors that sleep medicine/surgery fellowship program directors look for in applicants. Methods: Program directors from 9 sleep medicine/surgery fellowship programs in the USA were sent an anonymous online survey. They were asked to select the five most important academic factors (of a list of 17) when evaluating potential fellowship candidates, then rank those five in order of importance. They were then asked to do the same for the most important subjective criteria (of a list of 12). Results: Eight of 10 survey responses met inclusion criteria. Of the academic factors, strength of letters of recommendation, reputation of letter writer, and letters from sleep surgeons ranked highest. As for the subjective criteria, faculty assessment of the applicant on interview was ranked highest, followed by initiative and personality "fit" with the program. The reputation of an applicant's residency was ranked as more important than the reputation of their medical school. An applicant's performance in residency was assessed as more predictive of their performance in fellowship than performance during the interview process or position on the rank order list for the match. Only one program has a United States Medical Licensing Examination (USMLE) Step, and a different program has an Otolaryngology Training Examination (OTE) score cutoff. Conclusion: Letters of recommendation and interview are the most important factors in the selection process for hybrid sleep medicine and surgery fellowship programs, followed by research and residency program reputation. Sleep surgery-specific experience is helpful. [ABSTRACT FROM AUTHOR]

Insomnia and obstructive sleep apnea (OSA) are 2 of the most prevalent sleep disorders and frequently co-occur. Therapy can be challenging as treatment of 1 disease may worsen the other. Cognitive behavioral therapy for insomnia is the first-line treatment for insomnia and has been shown to improve compliance with positive airway pressure therapy. Other alternatives to OSA treatment may have higher acceptance in those with comorbid insomnia and sleep apnea (COMISA), such as mandibular advancement devices or emerging pharmacotherapies. Surgery, particularly hypoglossal nerve stimulation, appears to be well tolerated and may improve insomnia in those with COMISA. Otolaryngologists must be cognizant of the common presentation of COMISA in patients seeking surgical treatment and utilize a multidisciplinary approach to the treatment of these complex patients., Competing Interests: Disclosure Kathleen Sarber has no conflicts of interest to disclose. Reena Dhanda Patil has no conflicts of interest to disclose., (Published by Elsevier Inc.)

Candidacy evaluation for hypoglossal nerve stimulation (HGNS) is resource intensive. This proof-of-concept study investigates use of in-office volitional snore during flexible laryngoscopy as an efficient, cost-effective screening tool for HGNS evaluation. Adults with moderate to severe obstructive sleep apnea that failed continuous positive airway pressure treatment (n = 41) underwent evaluation for HGNS from 2018 to 2019. Volitional snore and drug-induced sleep endoscopy (DISE) data were collected and scored by VOTE classification (velum/palate, oropharynx, tongue base, epiglottis). A chi-square test of independence was performed that demonstrated a significant relationship between volitional snore and DISE (χ2 = 4.39, P =.036) for velum collapse pattern. Sensitivity and specificity of volitional snore for detecting velum collapse pattern were 93.6% (95% CI, 75.6%-99.2%) and 40% (95% CI, 12.2%-73.8%), respectively, illustrating its utility in screening for HGNS. Patients who demonstrate anterior-posterior velum collapse on volitional snore may be excellent candidates for confirmatory DISE at the time of HGNS implantation. [ABSTRACT FROM AUTHOR]

Purpose: Sleep surgery and mandibular advancement devices (MAD) are treatments for obstructive sleep apnea (OSA), but their comparative efficacy remains unclear. We compared their efficacy using various parameters. Methods: Subjects treated for OSA with sleep surgery or MAD (n = 30/group)—matched for sex, body mass index (BMI), and baseline apnea–hypopnea index (AHI)—were enrolled. The efficacy of these treatments according to polysomnographic parameters, sleep quality questionnaires, and heart rate variability (HRV) time- and frequency-domain parameters were compared between pre-treatment and 3-month post-treatment. Results: Polysomnographic and sleep quality questionnaire parameters improved significantly in both groups. In time-domain HRV analysis, average normal-to-normal intervals increased significantly in the surgery (942.2 ± 140.8 to 994.6 ± 143.1, P = 0.008) and MAD (901.1 ± 131.7 to 953.7 ± 123.1, P = 0.002) groups. Low frequency (LF) decreased significantly in the surgery group (P = 0.012); high frequency (HF) remained unchanged in both groups. The LF/HF ratio decreased in both groups (2.9 ± 1.8 to 2.3 ± 1.7, P = 0.017, vs. 3.0 ± 1.8 to 2.4 ± 1.4, P = 0.025). Normalized high frequency increased significantly in both groups (31.0 ± 13.2 to 36.8 ± 13.7, P = 0.009, vs. 29.1 ± 10.7 to 33.7 ± 12.5, P = 0.024), in contrast to normalized low frequency. However, no HRV parameter changes differed significantly between the groups after adjusting for age, BMI, and AHI. Conclusion: Sleep surgery and MAD are equally effective treatments for OSA according to cardiac autonomic activity. [ABSTRACT FROM AUTHOR]

Objective: To determine if a modified tissue-preserving palatopharyngoplasty could convert retropalatal concentric collapse to anteroposterior or lateral patterns of collapse on drug-induced sleep endoscopy (DISE) in patients who are not candidates for upper airway stimulation due to complete circumferential collapse at the velum.Methods: A prospective, nonconsecutive, single-blinded cohort study was performed by two sleep surgeons at a tertiary care center from 2015 to 2018. Inclusion criteria included adults > 18 years of age with a diagnosis of obstructive sleep apnea with an Apnea-Hypopnea Index (AHI) > 15, a body mass index (BMI) < 32, and < 25% central apneas on polysomnography. Twelve patients with complete circumferential collapse underwent a modified palatopharyngoplasty. Postoperatively, a repeat sleep study was performed. A repeat DISE was recommended for those with incomplete surgical response (clinically and/or AHI).Results: Twelve patients with complete circumferential collapse were eligible for the study. Mean BMI was 30.5. Mean preoperative AHI was 54.0 events per hour. Following a modified palatopharyngoplasty, the mean AHI was reduced to 33.1 events per hour, and 100% (12 of 12) of the patients converted from a pattern of complete circumferential collapse to either no collapse at the level of the velum (3) or an anteroposterior pattern of collapse (9).Conclusion: We demonstrate that a modified palatopharyngoplasty can successfully convert collapse patterns in patients with complete circumferential collapse. Further studies are required to determine the outcome of these patients following upper airway stimulation implantation.Level Of Evidence: 1B Laryngoscope, 2020. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Hypoglossal nerve stimulation (HGNS) effectively treats obstructive sleep apnea in select patients. Drug-induced sleep endoscopy (DISE) is required for HGNS candidacy. Data suggest that mandibular advancement (MA) devices and HGNS share similar target populations. We aimed to test the association between MA's effect on the velum and lateral walls during DISE in relation to the improvement in the apnea-hypopnea index (AHI) with HGNS.Study Design: Prospective case series METHODS: All patients completed preoperative polysomnography or home sleep study, DISE with MA prior to HGNS implantation, and full-night efficacy sleep tests. Adult patients with body mass index (BMI) ≤ 35 and AHI ≥ 15 were included. Two independent reviewers scored DISE videos.Results: Forty-six patients were included from October 2015 to January 2019. Mean BMI (standard deviation) was 28.5 (3.7) kg/m2 . Patients with a reduced airway response to MA had greater AHI improvement than patients with a robust response (21.7, 95% confidence interval [CI]: 14.4 to 29.0 vs. 4.9, 95% CI: -8.9 to 18.6; P = .03). Patients with complete baseline collapse at the velum and lateral walls (n = 11) had less response compared to those with partial collapse (n = 35) (AHI reduction of 4.4 [95% CI: -8.6 to 17.4] vs. 22.3 [95% CI: 15.1 to 29.6; P = .02]).Conclusions: Patients having significant airway improvement in the upper pharynx with MA during DISE appear less likely to succeed with HGNS. This phenomenon might be secondary to the worsened baseline obstruction of the upper pharynx in such patients.Level Of Evidence: 4 Laryngoscope, 2020. [ABSTRACT FROM AUTHOR]

Objective: Demonstrate the potential of the 4K-3D exoscope during upper airway stimulation surgery (UAS). Methods: A proof-of-concept study was performed to evaluate the feasibility of the exoscope during three consecutive UAS. Results: The exoscope was employed during UAS including cuff electrode and sensing lead placement. Three cases were successfully completed without adverse perioperative event; mean operative time was 200 minutes (range 188-218 minutes) with a successive reduction in operative time. Conclusion: This experience demonstrates the potential viability of the exoscope for UAS; it is a safe, innovative, and effective alternative or adjunct to existing visualization modalities. Notable advantages include improved ergonomics, unobstructed surgical field access, wide depth of field visualization, and short learning curve. Future technological enhancements could allow the exoscope to become a promising next-generation tool in the armamentarium of the contemporary sleep surgeon. [ABSTRACT FROM AUTHOR]

Sleep-disordered breating (SDB), including obstructive sleep apnea–hypopnea syndrome (OSAS) is a clinical syndrome mainly characterized by recurrent upper airway collapse during sleep, which leads to snoring, respiratory disturbance, sleep interruption, hypoxemia, and subsequent chronic diseases. The options for intervention of OSAS include continuous positive airway pressure (CPAP), sleep surgery, body weight reduction, and so on. In the past decades, technology has had a huge impact on the diagnosis and treatment of sleep disorders. We reviewed the literature of recent years and summarized the progress of technology in sleep surgery. Computer-assisted algorithm and airway fluid dynamics have been facilitating the airway evaluation of patients with SDB. Accurate measurement of the obstruction plane and extent of the upper airway are helpful for targeted surgery. Wearable devices and smart bedding make patient monitoring more convenient and comfortable. Technology is making surgical procedures less invasive and allowing patients who don't tolerate CPAP to improve symptoms and/or experience remission. [ABSTRACT FROM AUTHOR]

Purpose: The aim of our randomized clinical trial is to produce stronger evidence supporting barbed repositioning pharyngoplasty (BRP) as a therapeutic option for the treatment of obstructive sleep apnea (OSA). Methods: The trial was a single-center prospective controlled trial with two parallel arms (group A: BRP; group B: observation) and randomization. Baseline and 6-month polygraphy evaluating the apnea hypopnea index (AHI), oxygen desaturation index (ODI), and lowest oxygen saturation (LOS) were performed. To test the differences among groups of Student's t test, the role of each factor (univariate analysis) and their independent effect (multivariate analysis) was explored using logistic regression model as appropriate. Linear regression was also conducted. Results: A significant reduction of AHI, ODI, LOS, and Epworth Sleepiness Scale (ESS) values was recorded in the BRP group. BRP showed to be more effective than observation. Logistic regression showed that preoperative AHI is related significantly to postoperative AHI within the BRP group. A linear regression showed that higher baseline AHI predicts more significant postoperative absolute AHI reduction. Conclusions: BRP appears to be a promising technique and might be included within the surgical armamentarium of a sleep surgeon. Patients affected by severe OSA may benefit from this surgery with more significant reduction of AHI values. [ABSTRACT FROM AUTHOR]

An accurate benchtop model was developed to mimic the different forms of human upper airway collapse in adult sleep apnea patients. This was done via modeling the airway through digital imaging. Airway representative models were then produced in two steps via a customized pneumatic extrusion 3D printing system. This allowed the pressure of collapse and planes of collapse to be manipulated to accurately represent those seen in sleep apnea patients. The pressure flow relationships of the collapsible airways were then studied by inserting the collapsible airways into a module that allowed the chamber pressure (Pc) around the airways to be increased in order to cause collapse. Airways collapsed at physiologically relevant pressures (5.32–9.58 cmH2O). Nickel and iron magnetic polymers were then printed into the airway in order to investigate the altering of the airway collapse. The introduction of the nickel and iron magnetic polymers increased the pressure of collapse substantially (7.38–17.51 cmH2O). Finally, the force produced by the interaction of the magnetic polymer and the magnetic module was studied by measuring a sample of the magnetic airways. The peak force in (48.59–163.34 cN) and the distance over which the forces initially registered (6.8–9.7 mm) were measured using a force transducer. This data set may be used to inform future treatment of sleep apnea, specifically the production of an implantable polymer for surgical intervention. [ABSTRACT FROM AUTHOR]

Objective: The effectiveness of upper airway stimulation via hypoglossal nerve stimulation for obstructive sleep apnea depends upon the pattern of tongue muscle activation produced. This study investigated the nature of contralateral tongue muscle activation by unilateral hypoglossal nerve stimulation using intraoperative nerve integrity monitoring in conjunction with electromyography and explored the relationship between contralateral tongue muscle activation and polysomnographic measures of obstructive sleep apnea severity.Study Design: Prospective case series.Setting: Tertiary care medical center.Subjects and Methods: Fifty-one patients underwent unilateral (right) hypoglossal nerve stimulator implantation for obstructive sleep apnea. Neurophysiological data included electromyographic responses in ipsilateral (right) and contralateral (left) genioglossus muscles in response to intraoperative bipolar probe stimulation (0.3 mA) of medial hypoglossal nerve branches. Clinical data included pre- and postoperative apnea-hypopnea indices and oxygen desaturation levels.Results: A subset of patients (20/51, 39%) exhibited electromyographic responses in both the ipsilateral and contralateral genioglossus (bilateral), whereas the remaining patients (31/51, 61%) exhibited electromyographic responses only in the ipsilateral genioglossus (unilateral). The baseline characteristics of bilateral and unilateral responders were similar. Both groups exhibited significant and comparable improvements in apnea-hypopnea index and oxygen desaturations after hypoglossal nerve stimulation. Neither the amplitude nor the latency of contralateral genioglossus responses was predictive of clinical outcomes.Conclusion: A subset of patients undergoing unilateral hypoglossal nerve stimulation exhibits activation of contralateral genioglossus muscles. Patients with unilateral and bilateral genioglossus responses exhibit comparable, robust improvements in apnea-hypopnea index and oxygen desaturation levels. [ABSTRACT FROM AUTHOR]

Objectives: To analyze the resource utilization of performing drug-induced sleep endoscopy (DISE) procedures in an endoscopy suite (ES) setting as compared with the operating room (OR).Study Design: A retrospective review of DISE procedures performed by a single attending surgeon from 2016 to 2018.Setting: Tertiary hospital.Subjects and Methods: All patients undergoing sleep endoscopy without concurrent surgical procedures were included. No exclusion criteria were incorporated. Analysis assessed for differences in procedure-related expenditures, patient characteristics, anesthesia and surgeon time, and access to care.Results: A total of 87 sleep endoscopies were included: 65 (74.7%) performed in the ES and 22 (25.3%) in the OR. Patient groups were similar in age and apnea-hypopnea index severity (P > .05). Patient body mass index was significantly higher for the ES group (P = .03). Total facility time, postoperative recovery time, anesthesia care time, and time in the surgical room were significantly decreased in the ES setting (P < .01). Surgical time was similar between the groups (P > .05). For ES procedures, total cost was reduced by 74% (P < .01). DISE in the ES resulted in a mean $5080 less in health system charges versus the OR group (P < .01). There were no treatment-related complications in either setting.Conclusion: The resource utilization profile of performing DISE can be significantly improved by transferring these procedures from the OR to the ES setting. [ABSTRACT FROM AUTHOR]

Objective: Examine the patient characteristics of those undergoing upper airway stimulation (UAS) for the treatment of continuous positive airway pressure (CPAP)-refractive obstructive sleep apnea (OSA) at a tertiary care medical center to determine objective clinical predictors of success.Methods: Retrospective chart review of the first 25 consecutive patients between August 2015 and December 2016 treated with UAS at a tertiary care academic center. Demographic data, medical and sleep history, pre- and postoperative polysomnography data, and sleep endoscopy findings were collected. Statistical analysis was performed using two-sided t test with bivariate and linear regression analysis.Results: In our cohort of 25 patients, mean age was 67.5 ± 7.6 years, and mean body mass index (BMI) was 28.2 ± 3.8 kg/m2 with 42% female. One patient was excluded from analysis for unmasking of complete central apnea with therapy. AHI decreased by a mean of 33.8 events/hour following treatment (95% confidence interval: 25.8 to 41.7, P < 0.001). Preintervention AHI was associated with therapy response, with each point of preintervention AHI leading to an average decrease of 1.03 points (P < 0.001). Eighty-three percent of patients achieved a treatment AHI < 5, whereas 92% achieved an AHI < 10. Mean device use was 49.5 ± 10.4 hours per week. Ninety-two percent of patients were discharged the day of surgery. No major adverse events occurred.Conclusion: UAS continues to gain popularity for the treatment of CPAP-refractive OSA; therefore, identification of predictors of success is crucial. Our study, although small, suggests that more severe preintervention AHI does not preclude significant therapy response and may expand the inclusion criteria for UAS, meriting further investigation.Level Of Evidence: 4 Laryngoscope, 130:556-560, 2020. [ABSTRACT FROM AUTHOR]

Introduction: Transpalatal advancement (TPA) is a procedure that is used when modern variants of uvulopharyn-gopalatoplasty are unable to provide enough anterior traction. Although successful in reduction of obstructive sleep apnea (OSA) parameters, it also comes with procedure-specific risks. Formation of an oro-nasal fistula (ONF) is a complication that results in significant morbidity and a protracted treatment course. Methods: After approval from the University of Wollongong Health Research Ethics Committee, a retrospective chart review of all cases undergoing TPA performed by a single surgeon over a 10-year period from 2008 to 2018 was performed. Patients underwent pre- and postoperative level 1 or 2 polysomnography. Factors potentially contributing to palatal complications, as well as pre- and postoperative polysomnographic parameters, subjective sleep questionnaires, and body mass index (BMI) were statistically analyzed where a P value <.05 was considered a significant result. Results: A total of 59 patients were included. Overall palatal complication rate was 25.4% (15/59), with the most common being transient velo-palatal insufficiency (VPI) (8/59, 13.6%). ONF developed in 4/59 (6.8%) of patients. None of the analyzed contributing factors for palatal complications were statistically significant, except the presence of a high-arched palate and development of ONF. All analyzed sleep parameters, as well as BMI, were significantly different when comparing pre- to postoperative results. Conclusion: This study suggests that TPA has a role in current sleep surgery paradigms and can significantly improve both objective and subjective outcome measures of OSA. Surgeons contemplating TPA on patients with high-arched hard palates should do so with caution. [ABSTRACT FROM AUTHOR]

Abstract Background Patients are accessing online health information frequently and using it to guide treatment decisions. Few studies have been done assessing obstructive sleep apnea (OSA) information, and no studies have examined surgical resources for these patients. Methods This was a cross-sectional analysis. “Sleep surgery” and “sleep apnea surgery” were entered into Google, MSN Bing, and Yahoo! search engines. The first 25 results of each individual search were evaluated. Each unique site was assessed for content quality, accessibility, usability, reliability, and readability using validated instruments. The date of last update for each site was also documented. Results “Sleep surgery” was searched for an average of 1,703,991 (SD = 166,585) times per month from June 2015 to June 2016. 33 unique websites were identified. Sites were most often academically/government affiliated (10/33, 30.3%), health information sites (8/33, 24.2%), or non-profit/hospital related (8/33, 24.2%). The mean overall DISCERN score for quality was “good,” at 56.6 (range, 22–79). The mean overall LIDA score for accessibility, usability, and reliability was “moderate,” at 123.9 (range, 97–152). The mean Flesch Reading Ease score for readability was 49.77 (range 22.7-74.3); 7/33 (21.2%) scored above 60, the recommended range for average visitors. 60.6% (20/33) of the sites had been updated since January 1, 2014. There was no significant correlation between a websites’ position on a browser’s search and its DISCERN, LIDA, FRE, or total score. Conclusions With patients’ increasing reliance on Internet information, efforts to understand and improve websites’ quality and usefulness present unique opportunities in OSA surgery and beyond.

Objective: To evaluate the impact of age on safety, efficacy, and usage of upper airway stimulation (UAS).Study Design: Multicenter observational study.Setting: Thirteen US hospitals and 3 German hospitals.Subjects and Methods: The ADHERE registry is a multicenter database enrolling patients undergoing UAS implantation from October 2016 to April 2018. Outcome measures included the Epworth Sleepiness Scale, apnea-hypopnea index (AHI), therapy usage, and complications. Data were segmented by age (<65 vs ≥65 years).Results: Younger adults (n = 365) were a mean ± SD 52.7 ± 7.9 years old and 82% male, with a body mass index of 29.6 ± 3.8. Older adults (n = 235) were 71.1 ± 4.8 years old and 71% male, with a body mass index of 28.8 ± 3.8. Baseline AHI was similar (younger, 36.2 ± 15.9; older, 36.1 ± 14.8). Both groups had lower AHI at 12 months versus baseline (P < .001), but the older group showed a greater reduction (7.6 ± 6.9 vs 11.9 ± 13.4, P = .01). The Epworth Sleepiness Scale score decreased from 12.3 ± 5.4 to 7.1 ± 4.8 (P < .001) among younger adults and from 10.7 ± 5.7 to 6.3 ± 4.4 (P < .001) among older adults. Usage was slightly higher among older adults (6.0 ± 2.0 vs 5.4 ± 2.1 hours/night, P = .02). Surgical time was similar between younger patients (2.4 ± 0.7 hours) and older patients (2.3 ± 0.7 hours, P = .40), with comparably low complications.Conclusion: AHI reduction and therapy usage were found to be somewhat higher among patients aged ≥65 years who were treated with UAS. Surgical complications were low, in contrast to traditional sleep surgery. [ABSTRACT FROM AUTHOR]

Study Objectives: We evaluated the quality of ChatGPT responses to questions on obstructive sleep apnea for patient education and assessed how prompting the chatbot influences correctness, estimated grade level, and references of answers., Methods: ChatGPT was queried 4 times with 24 identical questions. Queries differed by initial prompting: no prompting, patient-friendly prompting, physician-level prompting, and prompting for statistics/references. Answers were scored on a hierarchical scale: incorrect, partially correct, correct, correct with either statistic or referenced citation ("correct+"), or correct with both a statistic and citation ("perfect"). Flesch-Kincaid grade level and citation publication years were recorded for answers. Proportions of responses at incremental score thresholds were compared by prompt type using chi-squared analysis. The relationship between prompt type and grade level was assessed using analysis of variance., Results: Across all prompts (n = 96 questions), 69 answers (71.9%) were at least correct. Proportions of responses that were at least partially correct ( P = .387) or correct ( P = .453) did not differ by prompt; responses that were at least correct+ ( P < .001) or perfect ( P < .001) did. Statistics/references prompting provided 74/77 (96.1%) references. Responses from patient-friendly prompting had a lower mean grade level (12.45 ± 2.32) than no prompting (14.15 ± 1.59), physician-level prompting (14.27 ± 2.09), and statistics/references prompting (15.00 ± 2.26) ( P < .0001)., Conclusions: ChatGPT overall provides appropriate answers to most questions on obstructive sleep apnea regardless of prompting. While prompting decreases response grade level, all responses remained above accepted recommendations for presenting medical information to patients. Given ChatGPT's rapid implementation, sleep experts may seek to further scrutinize its medical literacy and utility for patients., Citation: Campbell DJ, Estephan LE, Mastrolonardo EV, Amin DR, Huntley CT, Boon MS. Evaluating ChatGPT responses on obstructive sleep apnea for patient education. J Clin Sleep Med . 2023;19(12):1989-1995., (© 2023 American Academy of Sleep Medicine.)

Objective: Our aim in this study is to investigate, in patients who are advised to use CPAP, the rate of usage, differences between the patients who use the device and those who don't; and the factors affecting the compliance rates. Methodology: A telephone survey was applied to the patients who underwent polysomnography, between the years 2010 -2015 and were thereafter advised to use CPAP as the treatment method. RESULTS: Total number of patients included in the study was 108. Of them, 77 (71%) was male and 31 (29%) was female. The mean age was 50 (±11). There were 47 (43,5%) patients with comorbidities. Of 108 patients, 63 (58%) reported using CPAP at the time of the survey and 45 (42%) reported having abandoned the treatment, 62% (n: 28) of this 45 patients reported that they ceased the CPAP use within the first week of their treatment. Of 63 patients using CPAP, 3 (5%) was found noncompliant while 60 (95%) was found compliant. CONCLUSION: In our study, rate of CPAP use was found to be 55%. The difference between the mean ages of CPAP users and non-users was found statistically significant (p: 0,008). the results of our study suggests that BMI is not a factor that affects the rate of CPAP use. In our study, contrary to what would be expected, the mean CPAP pressure of the patients using the device were found to be higher than that of non-users. [ABSTRACT FROM AUTHOR]

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Background Most previous reports on palatal implantation for patients with severe obstructive sleep apnea have been anecdotal. Our objective in this study was to assess the long-term outcomes of palatal implantations from objective as well as subjective perspectives when applied to patients with severe obstructive sleep apnea and prominent retropalatal collapse. Methods This retrospective review was conducted in a single institution using subjective data (Epworth Sleepiness Scale and visual analog scales of snoring sounds and sleep quality) and objective data (respiratory disturbance index, minimum O 2 saturation, sleep efficiency, and snoring index using a polysomnograph) before and after surgery. A total of ten patients were enrolled in this study. The median time between pre-operative sleep-related tests and the operation date was 1.0 months and the median time between operation date and post-operative sleep-related tests was 33.0 months. Results Significant improvements were observed in the visual analog scale scores of snoring ( p = 0.004), visual analog scale scores of sleep quality ( p = 0.005), and Epworth Sleepiness Scale ( p = 0.012). Eight of the ten patients reported a reduction of at least 50% on the visual analog scale of snoring sounds, which was the criterion of subjective surgical success. We also observed significant improvements in the respiratory disturbance index ( p = 0.009) and minimum O 2 saturation ( p = 0.033). Two of the ten patients presented a reduction in respiratory disturbance index of ≥50% and a subsequent respiratory disturbance index of <20, which were the criteria of objective surgical success. A percentage change in respiratory disturbance index was negatively associated with prominent retrolingual collapse and the length of the soft palate. Conclusion Patients with severe obstructive sleep apnea and prominent retropalatal collapse may benefit from palatal implantation from a subjective perspective. Palatal implantation could be considered an alternate form of treatment for some cases of severe obstructive sleep apnea, due to the likelihood of improvement in clinical symptoms and the normalization of sleep quality. [ABSTRACT FROM AUTHOR]

Die Stimulationstherapie der oberen Atemwege stellt eine neue Therapieform für Patienten mit einer obstruktiven Schlafapnoe dar. In den vergangenen Jahren konnte die Evidenz stetig gesteigert werden, wobei die deutschen Implantationszentren hier einen wesentlichen Beitrag leisten konnten. Seit der ersten Implantation eines Schrittmachers der oberen Atemwege in Deutschland im Jahre 2009 wurde neben einem anhaltenden Effekt auf die Reduktion des Schweregrads der obstruktiven Schlafapnoe in mehreren Studien der positive Effekt der Therapie auf die subjektiv empfundene Schläfrigkeit der Patienten gezeigt. Untersuchungen zur Schlafarchitektur ergaben unter Therapie eine Verringerung des N1-Anteils, und es zeigten sich Hinweise auf einen REM-Rebound. Die Ergebnisse der Untersuchung der Therapienutzung ergaben einen durchschnittlichen Wert von 5,7 h Nutzung pro Nacht. In weiteren Untersuchungen konnten Erkenntnisse zum Wirkmechanismus der Stimulationstherapie gewonnen werden. Mit der Verbreitung der Stimulationstherapie wurde der Stellenwert einer möglichst exakten Vorstellung zur Anatomie auch des distalen N. hypoglossus zunehmend bedeutender. So konnte ein Klassifikationssystem des Nervs entwickelt werden, das die Platzierung der Stimulationselektrode für zukünftige Chirurgen erleichtern soll. Der Einsatz verschiedener Verfahren zur Beurteilung des Effektes der Therapie auf die oberen Atemwege wird untersucht. [ABSTRACT FROM AUTHOR]

Objective Evaluate peri-operative course and morbidity in children with Down syndrome (DS) who underwent a lingual tonsillectomy (LT) for residual obstructive sleep apnea (rOSA). Methods Retrospective case series for children with DS who underwent LT for rOSA from April 2011 to July 2016. Our primary outcomes were length of stay, readmission and complications. Surgical effectiveness was evaluated by change in the obstructive apnea-hypopnea-index(OAHI) and oxygen saturation nadir. Results Thirty-nine patients underwent LT. The mean length of stay was 1.3 days with n = 21(72%) staying one night. One subject (2.6%) had a post-operative bleed that did not require operative intervention. No other major complications occurred. In terms of effectiveness of surgery, twenty–nine children had sufficient data for inclusion. Median OAHI did not appreciably change (p = 0.07) from before surgery. Five subjects (17%) were cured of OSA (OAHI < 2/hour) and a mix of improvement and worsening was identified. The lowest oxygen saturation improved from 78% (SD = 7) before surgery to 82% (SD = 6) after surgery (p = 0.003). Conclusion LT has a favorable post-operative course but its effectiveness at curing rOSA in the DS population has not been established/proven. Further research is indicated to determine optimal surgical management for DS children with LTH. Level of evidence 4. [ABSTRACT FROM AUTHOR]