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OBJECTIVE: Obstructive sleep apnea (OSA) has many treatment options and the Internet is an important resource for patients. The quality of information reviewed by patients about sleep surgery is unknown. We assessed readability, accessibility, actionability, and quality of online content for OSA surgeries. STUDY DESIGN: Review of webpages by 2 independent reviewers. SETTING: Internet-based search. METHODS: We queried Google for sleep apnea surgery and included top 100 English language webpages. Content was scored by 2 reviewers using the Flesch-Kincaid (FK), Simple Measure of Gobbledygook (SMOG), JAMA benchmarks, CDC Clear Communication Index (CCI), and Patient Education Materials Assessment Tool (PEMAT) understandability and actionability scores. RESULTS: Eighty-seven webpages were evaluated including 40 hosted by academic hospitals, 23 private practices, 10 general knowledge, 4 national organizations, 3 industry, 3 non-profit hospitals, and 2 government-sponsored. Mean CCI ranged from 22.7% to 84.9%. No sources met the 90% CCI cutoff. Average PEMAT understandability score was 80.4% (±7.8; 62.5%-93.3%), with 91% meeting the 70% standard score. Average PEMAT-actionability score was 38.4% (±16.5; 0%-70%), with 5% meeting the standard score. The average readability of webpages was the 10th grade reading level. Only 5% of pages met the recommended 6th grade reading level or lower. Only 21% of pages addressed surgical risks. CONCLUSION: Most online resources regarding OSA surgery do not meet recommended standards for communication. Providers should be aware of limitations of materials when counseling patients on sleep surgery treatments. Future patient education resources should meet health communication and readability standards.

Surgical treatment of OSA has emerged as an effective alternative in continuos positive airway pressure (CPAP)-non-compliant group of patients. The present study examines the outcomes following a combination of barbed palatopharyngoplasty (BPP) and endoscopic coblator-assisted midline partial glossectomy in patients with multilevel obstruction of palate, oropharyngeal walls, and tongue base. A retrospective study of 40 patients with predominant obstruction at the velum, oropharyngeal lateral walls, and base of tongue levels, who underwent Barbed Palato Pharyngoplasty and Endoscopic coblator-assisted tongue base resection. Preoperative and post-operative Epworth Sleepiness Score (ESS), and Visual Analog Score (VAS) for snoring. Apnoea-Hypopnoea Index (AHI) and lowest oxygen saturation(L-Sat) were assessed by polysomnography. Improvement in qualityof life parameters were also evaluated. According to the AHI score, 55% of patients had severe OSA, while 45% of patients had moderate OSA. Sleep parameters like AHI, lowest oxygen saturation, and VAS score for snoring significantly improved after surgery (<0.0001). The overall success rate was 62.5%, according to Sher criteria. Following surgery, quality of life improvement in patient centered parameters was also observed in this study. Multilevel surgery with barbed palatopharyngoplasty combined with coblator-assisted midlie glossectomy is an effective treatment modality in patients with moderate-tosevere OSAS. The efficacy of combined surgical treatment was evidenced by improvements in PSG results and patient-centered quality of life parameters. [ABSTRACT FROM AUTHOR]

Objectives: Individuals with obstructive sleep apnea (OSA) suffer from a multitude of concurrent morbidities including cardiovascular disease (CVD). Limited data exists comparing long term cardiovascular disease (CVD) clinical outcomes for patients treated with surgical intervention versus continuous positive airway pressure (CPAP). The purpose of this study was to compare CVD outcomes at multiple time points comparing those treated with sleep surgery versus CPAP alone. Methods: A research database was used to assess outcomes: death, myocardial infarction, atrial fibrillation, heart failure, essential hypertension, and pulmonary hypertension at 5, 8, and 20 years for patients with OSA treated with surgical interventions (upper airway stimulation [UAS], uvulopalatopharyngoplasty [UPPP], and tonsillectomy) or CPAP alone. Subjects were identified using ICD and CPT codes and analyses were conducted with and without propensity score matching for age, sex, race, BMI, myocardial infarction (MI), essential hypertension, pulmonary hypertension, atrial fibrillation, and heart failure. Results: All surgical interventions demonstrated benefit over CPAP alone at most time points for most surgical interventions. At 8 years, for all sleep surgeries (UAS or UPPP or tonsillectomy) (n = 6627) versus treatment with CPAP alone (n = 6627), matched subjects demonstrated decreased risk (odds ratios) and superior survival (hazard ratios and log ranks tests) for death (OR = 0.49 [0.39, 0.62] P ≤.0001, HR = 0.29 [0.23, 0.37], χ2 = 109.58 P ≤.0001), myocardial infarction (OR = 0.67 [0.54, 0.84] P =.0005*, HR = 0.48 [0.38, 0.60], χ2 = 42.40 P ≤.0001), atrial fibrillation (OR = 0.70 [0.59, 0.83] P ≤.0001, HR = 0.54 [0.45, 0.64], χ2 = 51.53 P ≤.0001), heart failure (OR = 0.55 [0.47, 0.64] P ≤.0001, HR = 0.41 [0.35, 0.47], χ2 = 137.416 P ≤.0001), essential hypertension (OR = 0.88 [0.82, 0.94] P =.0002, HR = 0.78 [0.74, 0.82], χ2 = 76.38 P ≤.0001), and pulmonary hypertension (OR = 0.51 [0.40, 0.65] P ≤.0001, HR = 0.38 [0.29, 0.48], χ2 = 60.67 P ≤.0001) where P ≤.00037 indicated statistical significance*. Conclusion: This investigation suggests surgical management of obstructive sleep apnea may contribute to the mitigation of long-term clinical CVD morbidity. [ABSTRACT FROM AUTHOR]

Objective: To identify patient‐reported outcome measures (PROMs) used to measure adult obstructive sleep apnea (OSA)‐related quality of life in sleep surgery and analyze key psychometric properties in the original design and development of each PROM. Data Sources: PubMed, Web of Science, Embase, PsychINFO, and CINAHL. Review Methods: A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta‐analyses (PRISMA) guidelines. Disease‐specific instruments assessing sleep‐related quality of life that were used in sleep surgery studies and validated in patients with sleep disorders were included. The Consensus‐based Standards for the Selection of Health Status Measurement Instruments (COSMIN) criteria were used to evaluate methodological quality. Results: A total of 2494 abstracts were retrieved, and 216 underwent full‐text review. Seven PROMs assessing sleep‐related quality of life were identified. Only one (14%) PROM (SAQLI) was developed using both patient and physician input, and none were rated as "adequate" for content validity. Two PROMs utilized patients with sleep‐disordered breathing during content development and none specifically queried patients considering surgery. Six (86%) PROMs demonstrated "very good" analysis of internal consistency per COSMIN criteria, and six (86%) included data on test–retest reliability. Conclusion: Several PROMs are utilized in sleep‐related quality‐of‐life assessments for patients treated with OSA surgery. The measurement properties of these PROMs are of variable quality, and notably, no PROMs meet adequate quality measurements for content validity. New and updated PROMs for OSA‐related quality of life should consider input from sleep surgery patients and providers. Laryngoscope, 134:4838–4846, 2024 [ABSTRACT FROM AUTHOR]

Objective: To assess whether adenotonsillectomy improves levels of inflammatory and cardiometabolic markers in children with polysomnographically diagnosed obstructive sleep apnea (OSA). Data Sources: Two authors independently searched PubMed, Embase, and Cochrane databases up to August 16, 2022, for studies relating to pre‐ and post‐operative levels of serum markers in pediatric patients undergoing adenotonsillectomy. Review Methods: Data were extracted from included articles into a structured proforma. Meta‐analyses of the standardized mean difference (SMD) were conducted in random‐effects models. We calculated the probability of benefit (POB) and number needed to treat (NNT) for outcomes that demonstrated a statistically significant effect after adenotonsillectomy. The primary outcomes were changes in serum markers including C‐reactive protein (CRP), high‐sensitivity CRP (hs‐CRP), Insulin‐like growth factor 1 (IGF‐1), interleukin‐10 (IL‐10), interleukin‐6 (IL‐6), tumor necrosis factor‐alpha (TNF‐α), Brain natriuretic peptide (BNP), insulin, glucose, total cholesterol, triglyceride, low‐density lipoprotein (LDL), high‐density lipoprotein (HDL). Results: We screened 1616 studies and included 26 studies with 1331 participants. Meta‐analysis was performed on 20 of the included studies. Adenotonsillectomy was associated with a significant decrease in insulin levels (SMD = −0.322, 95% Confidence Interval (CI) = −0.583 to −0.061), CRP (SMD = −0.946, 95% CI = −1.578 to −0.314), and BNP (SMD = −1.416, 95% CI = −2.355 to −0.477) and significant increase in levels of IGF‐1 (SMD = 0.691, 95% CI = 0.207 to 1.176). There were no significant changes in levels of triglyceride, total cholesterol, TNF‐α, LDL, HDL, glucose, IL‐10, and IL‐6. Conclusion: In children with polysomnographically diagnosed OSA, adenotonsillectomy was associated with improvements in serum biomarkers, comprising lower CRP, insulin, and BNP, and higher IGF‐1. Laryngoscope, 134:3030–3037, 2024 [ABSTRACT FROM AUTHOR]

Objectives: Decisional conflict (DC) is high in obstructive sleep apnea (OSA) surgical candidates interested in positive airway pressure (PAP) alternatives. We evaluated the impact of pre‐consultation video decision aids on patient DC and decision readiness. Methods: Prior to consultation for PAP alternatives, adult OSA patients were enrolled and completed a questionnaire querying DC (scored 0 [no conflict]–100 [high conflict]) and decision readiness. Those considering ≥3 treatment options were categorized as "high‐conflict." Patients were randomized to either an intervention group with video review about PAP and surgical options prior to their visit or to a control group that received no video review. Audio recordings of clinic visits were analyzed for patient engagement. Results: Twenty‐five participants (control: n = 12, intervention: n = 13) were found to have comparably high DC (mean score: 40.0). Both groups experienced post‐visit improvements in DC scores (post‐consult: 25.2, p = 0.003) which did not differ between the two groups (intervention: 20.5 ± 15.1 vs. control: 11.7 ± 12.1 points, p = 0.13). The intervention group showed significant improvement in decision‐making stage after the visit, with 72.7% "close to selecting an option" (p = 0.04) versus 41.7% in the control group. Use of videos was not associated with any differences in patient satisfaction, engagement, or decision to pursue surgery (all p > 0.05). High‐conflict patients (n = 5) who reviewed pre‐visit videos (intervention sub‐group) spoke fewer words during the visit (687 ± 139 vs. 1120 ± 389 words, p = 0.047) and had shorter visit times (18.7 ± 2.9 vs. 24.3 ± 3.1 min, p = 0.02) than high‐conflict control patients. Conclusions: Patients have high levels of DC when considering PAP alternatives. Use of video decision aids prior to sleep surgery consultation may improve the treatment decision‐making process. Level of Evidence: 2 Laryngoscope, 134:2958–2963, 2024 [ABSTRACT FROM AUTHOR]

BackgroundEvaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA).MethodsUsing previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus.ResultsThe ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated.ConclusionThis review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.

Abstract 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

OBJECTIVES: To characterize the treatment goals and values of adult patients with obstructive sleep apnea (OSA). STUDY DESIGN: Mixed methods design based on semistructured interviews followed by cross-sectional surveys. SETTING: Academic medical center and integrated managed care consortium. METHODS: Phase 1 involved qualitative analysis of focus groups and interviews to define treatment goal categories. Phase 2 included analysis of cross-sectional surveys on most important treatment goals from patients with OSA presenting to sleep surgery clinic. Positive airway pressure (PAP) use, Epworth Sleepiness Scale score, and apnea-hypopnea index were obtained to determine influences on goal choices. RESULTS: During focus groups and interviews, treatment goal themes identified included improving sleep quality, reducing daytime sleepiness, snoring sound reduction, and health risk reduction. In phase 2, 536 patients were surveyed, and they reported the primary treatment goals of health risk reduction (35%), sleep quality improvement (28%), daytime sleepiness improvement (21%), and snoring sound reduction (16%). The primary treatment goal was associated with age (P < .0001), excessive daytime sleepiness (Epworth Sleepiness Scale score >10, P < .0001), PAP use status (P < .0001), and OSA severity (apnea-hypopnea index, P < .0001). Severity of OSA was associated with increasing proportion of patients choosing health risk reduction as the main treatment goal (P < .05). CONCLUSIONS: Adult OSA treatment goal choices vary with age, symptoms, PAP history, and OSA severity. Understanding patient-specific goals is the essential first step in the shared decision-making process when choosing surgical or nonsurgical treatments. Ultimately, goal-focused discussions ensure alignment of priorities and definitions of success between the patient and the provider.

Aim: As the craniofacial morphology has major effects on the occurrence of obstructive sleep apnea (OSA) in Asians, factors contributing to the severity of OSA may differ depending on craniofacial characteristics. This study investigated factors affecting OSA severity in patients according to craniofacial morphological type. Methods: Study participants comprised 227 men examined following a diagnosis of OSA between May 2017 and October 2021. We examined cephalometric X‐rays and results of polysomnography on presentation, and classified the craniofacial morphological type of the participant as "long face type" (Group L) for facial axis (Fx) angle <86° or as "short face type" (Group S) for Fx angle ≥86°. We conducted stepwise binomial logistic regression analysis with apnea‐hypopnea index (AHI) ≥ 15 events/h or AHI < 15 events/h as the dependent variable and age, body mass index (BMI), and the cephalometric parameters SNA, SNB, Fx, PNS‐P, MPT, MP‐H, SPAS, MAS, and IAS as independent variables. Results: BMI and PNS‐P in Group S and BMI and MP‐H in Group L were identified as independent predictors of AHI ≥ 15 events/h. Conclusions: Factors affecting severity of OSA differ by craniofacial morphological type, with factors of obesity and hyoid bone position for long face‐type patients and obesity and soft palate length for short face‐type patients. Optimal treatment requires consideration of craniofacial morphology and establishment of treatment policies that take causative factors into account. [ABSTRACT FROM AUTHOR]

Objective: We aimed to determine the preoperative prevalence of insomnia in the Adherence and Outcomes of Upper Airway Stimulation for OSA International Registry (ADHERE) and to examine serial sleep‐related data longitudinally, in particular the Insomnia Severity Index (ISI), to compare outcomes between patients with no/subthreshold insomnia (ISI < 15) and moderate/severe insomnia (ISI ≥ 15) at baseline. Methods: We analyzed observational data from ADHERE between March 2020 and September 2022. Baseline demographic and mental health (MH) data, apnea hypopnea index (AHI), ISI, and ESS (Epworth Sleepiness Scale) were recorded. At post‐titration (PT) and final visits, AHI, ISI, ESS and nightly usage were compared between baseline ISI < 15 and ISI ≥ 15 subgroups. Results: A baseline ISI was obtained in 928 patients (62% with ISI ≥ 15). Of the 578 and 141 patients reaching the 12‐ and 24‐month time periods to complete PT and final visits, 292 (50.5%) and 91 (64.5%) completed the ISI, respectively. Baseline MH conditions were higher with ISI ≥ 15 than ISI < 15 (p < 0.001). AHI reduction and adherence did not differ between patients with baseline ISI ≥ 15 and ISI < 15. Patients with ISI ≥ 15 experienced greater improvement in ESS than ISI < 15 at post‐titration and final visits (p = 0.014, 0.025). All patients had improved nocturnal, daytime, and overall ISI scores at follow‐up visits (p < 0.001), especially for those with baseline ISI ≥ 15 compared with ISI < 15 (p < 0.05). Conclusion: HGNS therapy efficacy and adherence were similar between ISI severity subgroups at follow‐up visits. Insomnia and sleepiness scores improved in all patients with HGNS therapy and to a greater degree in patients with baseline moderate/severe insomnia. Level of Evidence: 4 Laryngoscope, 134:471–479, 2024 [ABSTRACT FROM AUTHOR]

Objectives: The influence of apnea‐ and hypopnea‐predominance on hypoglossal nerve stimulation therapy outcomes (HGNS) is still poorly defined. We assessed the significance of apnea‐ and hypopnea‐predominance in HGNS outcomes. Study Design: Case series with chart review. Setting: Single‐institution tertiary care center. Methods: A total of 216 subjects were included, all of which had undergone drug‐induced sleep endoscopy (DISE) and HGNS implantation. Demographic and polysomnographic data were collected. The 4% apnea‐hypopnea criteria were used to calculate apnea‐hypopnea index (AHI). Central apneas were omitted. Univariate logistic and linear regression were used to study the association between these data and apnea‐predominance and hypopnea‐predominance. Kruskal‐Wallis rank sum test was used to compare medians between groups for DISE collapse patterns. Results: Sixty‐three patients were apnea‐predominant, and 153 patients were hypopnea‐predominant. These 2 groups were similar demographically (p >.20). There was no significant difference in HGNS outcomes between the groups assessed using Sher20 criteria at the 1‐year mark using all‐night, single‐setting polysomnography or home sleep studies. Apnea index (AI)/AHI and reduction in AHI from preoperative to titration were significantly associated (p =.046). The median preoperative hypopnea index was significantly lower (p =.033) in subjects with no oropharyngeal collapse than patients with partial or complete oropharyngeal collapse. There were no significant relationships between AI/AHI and the different degrees of collapse at the velopharynx, oropharynx, tongue base, or epiglottis. Conclusions: In line with CPAP, tonsillectomy, and mandibular advancement therapy studies, we found there was largely no significant difference in DISE anatomy or in HGNS treatment outcomes between apnea‐ and hypopnea‐predominant individuals. [ABSTRACT FROM AUTHOR]

Abstract Objective Obstructive sleep apnea (OSA) has many treatment options and the Internet is an important resource for patients. The quality of information reviewed by patients about sleep surgery is unknown. We assessed readability, accessibility, actionability, and quality of online content for OSA surgeries. Study Design Review of webpages by 2 independent reviewers. Setting Internet‐based search. Methods We queried Google for sleep apnea surgery and included top 100 English language webpages. Content was scored by 2 reviewers using the Flesch‐Kincaid (FK), Simple Measure of Gobbledygook (SMOG), JAMA benchmarks, CDC Clear Communication Index (CCI), and Patient Education Materials Assessment Tool (PEMAT) understandability and actionability scores. Results Eighty‐seven webpages were evaluated including 40 hosted by academic hospitals, 23 private practices, 10 general knowledge, 4 national organizations, 3 industry, 3 non‐profit hospitals, and 2 government‐sponsored. Mean CCI ranged from 22.7% to 84.9%. No sources met the 90% CCI cutoff. Average PEMAT understandability score was 80.4% (±7.8; 62.5%‐93.3%), with 91% meeting the 70% standard score. Average PEMAT‐actionability score was 38.4% (±16.5; 0%‐70%), with 5% meeting the standard score. The average readability of webpages was the 10th grade reading level. Only 5% of pages met the recommended 6th grade reading level or lower. Only 21% of pages addressed surgical risks. Conclusion Most online resources regarding OSA surgery do not meet recommended standards for communication. Providers should be aware of limitations of materials when counseling patients on sleep surgery treatments. Future patient education resources should meet health communication and readability standards.

(1) Background: This narrative review aims to explore the predictors of success for pharyngeal surgery in the treatment of obstructive sleep apnea (OSA). An extensive literature search was conducted, identifying relevant studies published up to June 2023, utilizing various databases and key search terms related to OSA, surgical interventions, and predictors of success. The review encompasses both retrospective and prospective studies, case series, and cohort studies to provide a broad understanding of the topic; (2) Methods: Review of English scientific literature on phenotypes of OSA related to predictors of success of pharyngeal surgery; (3) Results: Of 75 articles, 21 were included, in these the following were determined to be factors for surgical success: body mass index (BMI) (8 articles), apnea/hypopnea index (AHI) (8 articles), cephalometry (8 articles), palatine tonsil size (7 articles), Modified Mallampati score (2 articles), genioglossus electromyography (2 articles), Friedman score or upper airway anatomy (3 articles), nasopharyngolaryngoscopy (2 articles), drug-induced sleep endoscopy (DISE) (1 article), oral cavity anatomy (1 article) and oxygen desaturation index (ODI) (1 article); (4) Conclusions: The lack of standardized protocols for the indication of pharyngeal surgery is a reality, however identifying known predictors of surgical success may facilitate homogenizing indications. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effects of surgical treatment on fatigue, stress, and resilience in patients with obstructive sleep apnea (OSA). Methods: Sixty patients who underwent multilevel sleep surgery for OSA (OSA group) and 32 non-OSA participants (control group) were recruited at a university hospital in Korea between January 2020 and March 2022. Fatigue, stress, and resilience levels were evaluated in both groups using the Chalder fatigue scale (CFS), daily hassles scale revised (DHS-R), and Connor–Davidson resilience scale (CD-RISC), respectively. The scores of each group were compared before and 6 months after surgery. Results: The initial CFS and DHS-R scores were significantly higher, while the CD-RISC score was significantly lower, in the OSA group than in the control group (p < 0.05). In the patients with OSA, all three scores significantly improved after surgery (p < 0.05). Additionally, when compared between the groups at 6 months, there were no differences in the CFS, DHS-R, or CD-RISC scores (p > 0.05). Even when the OSA group was divided into a success group and a failure group according to surgical outcomes and compared with the control group, the three scores of both groups did not show statistical differences from the control group (p > 0.05). Conclusions: Multilevel surgery may reduce fatigue as well as stress and increase resilience in patients with OSA to levels similar to those in non-OSA individuals. [ABSTRACT FROM AUTHOR]

Introduction: Hypoglossal nerve stimulation (HNS) has recently been introduced as an alternative treatment for patients with OSA. A large number of studies have demonstrated substantial changes in OSA with this therapy by reducing respiratory events and improving symptoms such as daytime sleepiness and quality of life. The objective of this review was to conduct a systematic review and meta-analysis to evaluate patient-reported outcomes and experience with HNS therapy. Methods: A systematic literature search of MEDLINE, Cochrane, and Web of Science was performed to identify randomized controlled and observational studies reporting subjective outcomes with different HNS systems in patients with OSA. Abstracts of 406 articles were screened and a subset of 55 articles were reviewed for eligibility. Risk of bias was assessed using the ROBINS-I tool. Meta-analysis using RevMan was performed when > 2 studies were identified that reported data on a specific outcome. Results: Thirty-four publications reporting data on 3785 patients with a mean follow-up of 11.8 ± 12.2 months were identified and included in the meta-analysis. The analysis revealed a pooled effect of 4.59 points improvement in daytime sleepiness as measured by the ESS questionnaire (Z = 42.82, p <.001), 2.84 points improvement in daytime functioning as measured by the FOSQ score (Z = 28.38, p <.001), and 1.77 points improvement in sleep quality as measured by the PSQI questionnaire (Z = 2.53, p =.010). Patient-reported experience was consistently positive and revealed additional relevant aspects from this perspective. Conclusion: HNS therapy significantly improves quality of life in patients with OSA and reliably produces clinically meaningful effects on daytime sleepiness, daytime functioning, and sleep quality. Treatment regularly meets or exceeds the minimum clinically important differences defined for the respective instruments. Additional research is needed to further investigate effects on quality of life beyond improvements in daytime sleepiness and daytime functioning. [ABSTRACT FROM AUTHOR]

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Purpose: This systematic review aims to compare the efficacy and safety of multilevel and single level surgery, including barbed pharyngoplasties, in the treatment of obstructive sleep apnea (OSA). Methods: The study followed PRISMA guidelines and searched PubMed/MEDLINE, Google Scholar, and Ovid databases for studies evaluating the effect of barbed pharyngoplasties on adults with OSA. Prospective and retrospective cohort studies were included with pre- and post-treatment comparisons of sleep tests and self-reported clinical outcomes. Exclusion criteria were non-English studies, case reports, reviews, conference abstracts, letters, and pediatric studies. Successful surgery was classified using Sher's criteria. Results: The study selected a total of 1014 patients from 26 studies, 24 of which were longitudinal studies with 10 retrospective trials and 14 prospective studies. The average age of the patients was 46.9 years, with an average Body Mass Index (BMI) of 25.6 kg/m2. Most of the patients were male (84.6%). The study included only palatal surgical techniques with barbed sutures, and patients who underwent cardio-respiratory monitoring and Drug Induced Sleep Endoscopy (DISE) before surgery. Mean Apnea Hypopnea Index (AHI) preoperative was 32.9/h, AHI postoperative was 11.9/h, and mean reduction of AHI was 62.3%. The most commonly adopted palatoplasty was Barbed Repositioning Pharyngoplasty (BRP) in 16 out of 26 studies, followed by its subsequent modifications in 3 studies. Conclusions: Barbed pharyngoplasties appear to be effective both on objective measurement and subjective scores. DISE represents a fundamental tool to assess uni-level or multilevel obstruction. When retro-palatal collapse is present, barbed pharyngoplasty appears to be effective. Barbed pharyngoplasties maintain their good results both in single level or multilevel surgery. Randomized clinical controlled trials with multi-center cooperation and long-term study are necessary. [ABSTRACT FROM AUTHOR]

Objective: Drug‐induced sleep endoscopy (DISE) is a commonly used diagnostic tool for surgical procedural selection in obstructive sleep apnea (OSA), but it is expensive, subjective, and requires sedation. Here we present an initial investigation of high‐resolution pharyngeal manometry (HRM) for upper airway phenotyping in OSA, developing a software system that reliably predicts pharyngeal sites of collapse based solely on manometric recordings. Study Design: Prospective cross‐sectional study. Setting: An academic sleep medicine and surgery practice. Methods: Forty participants underwent simultaneous HRM and DISE. A machine learning algorithm was constructed to estimate pharyngeal level‐specific severity of collapse, as determined by an expert DISE reviewer. The primary outcome metrics for each level were model accuracy and F1‐score, which balances model precision against recall. Results: During model training, the average F1‐score across all categories was 0.86, with an average weighted accuracy of 0.91. Using a holdout test set of 9 participants, a K‐nearest neighbor model trained on 31 participants attained an average F1‐score of 0.96 and an average accuracy of 0.97. The F1‐score for prediction of complete concentric palatal collapse was 0.86. Conclusion: Our findings suggest that HRM may enable objective and dynamic mapping of the pharynx, opening new pathways toward reliable and reproducible assessment of this complex anatomy in sleep. [ABSTRACT FROM AUTHOR]

Objective: Patients undergoing surgical management for obstructive sleep apnea (OSA) are likely medically distinct from their counterparts not treated surgically. This study examined the associations between psychiatric and pain comorbidities and the likelihood of undergoing sleep surgery. Study Design: A retrospective cohort study of adults with OSA. Setting: Large integrated healthcare system. Methods: The primary outcome was nonnasal, nonbariatric sleep surgery. The associations of baseline demographic and comorbid conditions with surgery to treat underlying OSA were examined using bivariable and multivariable analyses. Results: Among 172,854 adults with OSA, 2456 received sleep surgery. Comorbid pain disorder and/or pain medication treatment was associated with 41% higher odds of surgery (95% confidence interval: 1.29‐1.54). In bivariable analyses, those with a history of headache (p =.004), particularly migraine (p =.003), disorders of adult personality or behavior (p =.025), or behavioral/emotional disorder (p <.001) were more likely to undergo surgery. Younger adults were also more likely to undergo surgery (mean age at diagnosis 39.8 ± 12.6 vs 54.7 ± 14 years), as were men, Asian/Pacific Islander or Hispanic adults, those with lower body mass index (32 ± 7 vs 34.3 ± 8.1 kg/m2), or those with Charlson Comorbidity Index of zero (p <.001). Conclusion: Our study suggests a history of pain disorder (including receipt of pain medication), migraine, or certain behavioral and personality disorders are associated with an increased likelihood of undergoing sleep surgery. The findings may better characterize comorbid predictors of sleep surgery and potentially help clinicians tailor expectations, postoperative pain management, and overall sleep outcomes. [ABSTRACT FROM AUTHOR]

Abstract Objective To further demonstrate sleep endoscopy's utility in improving surgical outcomes for pediatric OSA. Methods This is a retrospective review of surgically naïve patients 1. Results A total of 106 patients had preoperative and postoperative polysomnograms. Patients with comorbidities comprised 53.8% of the group. Average BMI% was 88.2, with 75.5% classified as obese. The most common area of collapse was the base of tongue, occurring in 32.1% of patients. There was a statistically significant decrease from the mean preoperative oAHI of 29.7 to the mean postoperative oAHI of 6.6 (p

Background: This international study aimed at determining current routine palate surgeries and surgical methods adopted by otolaryngologists who practice surgical management of obstructive sleep apnea (OSA). 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 routines in palatal procedures. The surgeons were asked 33 multiple-choice questions. Results: A total of 141 sleep surgeons answered the questionnaire, of whom 27% were from Africa, 30% from Asia, 24% from Centre-South America, and 19% from Europe. According to otolaryngology surgical specialties, 51% were sleep surgeons, 31% general ENTs, 8% Rhinologists, 7% Head & Neck surgeons, 2% otologists, and 1% maxillofacial surgeons. Of the 141 respondents, 51% answered they were sleep specialists, whereas 49% were non-sleep specialists. According to specific medical degree, 38% were specialists, 33% were consultants, 25% were professors, and 4% were residents or trainees. Conclusion: This study gives an overview of the current surgical practice in OSA management in otolaryngology in different countries. [ABSTRACT FROM AUTHOR]

Objective: To identify clinical and demographic characteristics of adults with obstructive sleep apnea (OSA) undergoing soft tissue and orthognathic sleep surgery, assess temporal trends in surgery type and proportion of women undergoing surgery, and provide clinical perspective before wide‐spread implementation of hypoglossal nerve stimulation (HGNS). Methods: In a retrospective cohort study, adults diagnosed with OSA from 2009 to 2016 were identified in a large integrated healthcare system. Characteristics between cohort members who did and did not undergo sleep surgeries were compared. Multivariable logistic regression models examined associations of different characteristics with whether surgery was performed. Results: Of 172,216 adults with OSA, 2,262 (1.3%) underwent sleep surgery during 2009–2017. The most common sleep surgery was palate surgery (56.9%), which decreased proportionately over time. In multivariable analysis, older age and obesity were associated with lower odds of undergoing surgery. Those who underwent tonsillectomy and adenoidectomy were more likely to have larger tonsils and not require additional surgery, whereas tongue reduction recipients were more likely to have severe OSA and require multiple surgery types. The proportion of women undergoing surgery increased over time (p < 0.001 from trend test). Conclusion: Clinical and demographic characteristics associated with soft tissue and orthognathic sleep surgery were identified in a large adult cohort prior to widespread implementation of HGNS. An increase in sleep surgery among women and a decrease in palate surgery over time were observed. The findings provide clinical perspective on sleep surgery performed prior to implementation of HGNS and may inform future studies examining its associations with patient characteristics. Level of Evidence: 3 Laryngoscope, 133:1262–1270, 2023 [ABSTRACT FROM AUTHOR]

Objective: To determine how surgery, continuous positive airway pressure (CPAP), and no treatment impact health care utilization in patients who have obstructive sleep apnea (OSA). Study Design: This is a retrospective cohort study of patients between the ages of 18 and 65 that were diagnosed with OSA (9th International Classification of Diseases) from January 2007 to December 2015. Data were collected over 2 years, and prediction models were generated to evaluate trends over time. Setting: A population‐based study using real‐world data and insurance databases. Methods: A total of 4,978,649 participants were identified, all with at least 25 months of continuous enrollment. Patients with previous soft tissue procedures not approved for OSA (nasal surgery), or without continuous insurance coverage were excluded. A total of 18,050 patients underwent surgery, 1,054,578 were untreated, and 799,370 received CPAP. IBM Marketscan Research database was utilized to describe patient‐specific clinical utilization, and expenditures, across outpatient, and inpatient services, and medication prescriptions. Results: When the cost of the intervention was eliminated in the 2‐year follow‐up, the monthly payments of group 1 (surgery) were significantly less than group 3 (CPAP) in overall, inpatient, outpatient, and pharmaceutical payments (p <.001). The surgery group was associated with less cumulative payments compared to the other 2 groups when the cost of the intervention (CPAP or surgery) was eliminated in all comorbidities and age groups. Conclusion: Treating OSA with surgery can lessen overall health care utilization compared to no treatment and CPAP. [ABSTRACT FROM AUTHOR]

Objective: To examine the accuracy and interrater reliability of a visually assessed vs airflow‐based measure of pharyngeal collapsibility obtained in patients with obstructive sleep apnea undergoing drug‐induced sleep endoscopy (DISE). Study Design: Prospective observational study. Setting: Academic tertiary care practice. Methods: Patients underwent DISE with airflow monitoring and nasal positive airway pressure titration to determine visual and airflow‐based levels of pharyngeal opening pressure (PhOP). Visual DISE‐PhOP was assessed by 2 blinded independent raters and defined as the pressure at which visual confirmation of airway collapse, including snoring, was abolished. Airflow‐based DISE‐PhOP was defined as the minimally effective positive airway pressure that abolished inspiratory flow limitation. Equivalence testing between visual and airflow DISE‐PhOP of each rater was performed with the two one sided T‐test (TOST) with an a priori equivalence bound of ±1 cm H2O. Interrater reliability was evaluated with the intraclass correlation coefficient. Results: One hundred patients were enrolled in the study and 77 completed the full evaluation. The population was predominantly male (74%) with an average age of 54.8 years, body mass index of 30.1 kg/m2, and apnea‐hypopnea index of 30.7 events/h. Equivalence testing showed that both raters were within ±1 cm H2O of airflow‐based DISE‐PhOP (−0.43 to 0.09 cm H2O and −0.32 to 0.48 cm H2O). Interrater reliability of visual DISE‐PhOP between the raters was also good to excellent with an intraclass correlation coefficient of 0.895 (95% CI, 0.84‐0.932). Conclusion: DISE‐PhOP, a measure of upper airway collapsibility, was equivalent between airflow‐based and visual assessments with strong interrater reliability, supporting its adoption as a standardized objective parameter in clinical DISE. [ABSTRACT FROM AUTHOR]

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Objective: There are several obstructive sleep apnea (OSA) treatment options available to patients, including surgery and less invasive therapies. Little is known about the factors that influence patient preferences for treatment. We aimed to understand factors influencing patient experience and decision making for undergoing sleep surgery. Study Design: Retrospective qualitative study. Setting: Tertiary sleep surgery clinic. Methods: We conducted semistructured interviews with adults who previously underwent any nasal and/or pharyngeal sleep surgery. We asked open‐ended questions about their decision‐making process within a preconceived thematic framework of chief OSA symptoms, expectations for recovery, and sources of information. The interviews were audio recorded and transcribed, and content was analyzed for defined, emergent, and prevalent themes. Results: Ten patients were interviewed from December 11, 2020 through January 29, 2021. Six patients underwent nasal surgery, 1 underwent pharyngeal surgery, and 3 underwent staged nasal and pharyngeal procedures. All patients were beyond the acute recovery phase. Reasons for pursuing surgical consultation varied from sleep apnea burden to external factors, such as recommendations from significant others. Duration of sleep surgery consideration varied from months to years. Major concerns about sleep surgery involved anesthesia and postoperative pain. External factors influencing patients' decisions to pursue sleep surgery included family and friend support. Postoperative outcomes of surgery included patient satisfaction with decision for surgery, given OSA improvements. Conclusion: Understanding patient factors that influence decision making for sleep surgery may guide clinicians in patient‐centered counseling that engages patients in decision making, aligning with clinical symptoms and patient preferences. [ABSTRACT FROM AUTHOR]

Abstract Objective To describe multilevel phenotypes of airway obstruction identified on drug‐induced sleep endoscopy (DISE) in adults. Study Design Retrospective chart review. Setting Tertiary care center. Methods Video recordings of DISE on adult patients were retrospectively scored. A cross‐correlation matrix was created to detect significant correlations between DISE findings at anatomical subsites. Three multilevel phenotypes resulted from the matrix: complete collapse at the tongue base with complete collapse at the epiglottis (T2‐E2), complete circumferential obstruction at the velum with complete lateral pharyngeal wall collapse at the oropharynx (V2C‐O2LPW), and incomplete collapse at the velum with complete collapse due to tonsillar hypertrophy (V0/1‐O2T). The mean difference (MD) and 95% confidence interval (CI) were calculated for demographic and polysomnogram metrics of each phenotype compared to all other subjects. Results Phenotype 1 (T2‐E2) (n = 88) had older ages (MD 5.784 years, CI [1.992, 9.576]), lower body mass index (BMI) (MD –1.666 kg/m2, CI [02.570, −0.762]), and smaller neck circumferences (MD –0.448 in., CI [−9.14, −0.009]) than the other phenotypes. Phenotype 2 (V2C‐O2LPW) (n = 25) had higher BMIs (MD 2.813 kg/m2, CI [1.362, 4.263]), higher neck circumference (MD 0.714 in., CI [0.004, 1.424]), and higher apnea‐hypopnea index (MD 8.252, CI [0.463, 16.041]). Phenotype 3 (V0/1‐O2T) (n = 20) had younger ages (MD –17.697, CI [−25.215, −11.179]). Conclusion Three distinct multilevel phenotypes of obstruction were identified on DISE, suggesting different anatomic subsites collapse in a nonrandom pattern. The phenotypes appear to represent distinct patient groups and their identification may have implications in terms of pathophysiology and treatment modalities.

Introduction: Morbidly obese patients with obstructive sleep apnea (OSA) are often intolerant of continuous positive airway pressure (CPAP). The effects of sleep surgery in this population is not well documented, and sleep surgery is generally avoided due to the expectation of poor outcomes, leaving these patients untreated. Methods: This retrospective study included 42 patients with a body mass index (BMI) ≥40.0 and OSA with a preoperative apnea hypopnea index (AHI) ≥5. Preoperative BMI ranged from 40.0 to 69.0 kg/m2. Preoperative AHI ranged from 7.2 to 130.0. Of 42 patients, 12 (28.6%) underwent concurrent pharyngeal and retrolingual surgery. Subgroup analysis of change in AHI was measured with respect to preoperative OSA severity, change in preoperative BMI, and BMI severity. Univariate linear and logistic regression was performed assessing change in AHI and surgical success with respect to age, sex, preoperative AHI, preoperative BMI, change in BMI, total procedures, palatal procedure, retrolingual procedure, nasal procedure, and multilevel procedures. Results: The mean AHI improved from 45.9 ± 31.8 to 31.9 ± 31.6 (P =.007). Epworth sleepiness score (ESS) improved from 13.2 ± 5.5 to 9.6 ± 5.4 (P =.00006). Lowest oxygen saturation (LSAT) improved from 74.4 ± 10.7 to 79.9 ± 10.4 (P =.002). About 33.3% of patients had surgical success (AHI < 20 with at least 50% reduction in AHI). Preoperative AHI was the most significant factor for change in AHI in univariate and multivariate models (P =.015). Conclusion: Sleep surgery is effective in reducing OSA burden in most morbidly obese patients and can result in surgical cure for a third of patients. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to outline a protocol utilizing propofol infusion without an initial bolus during drug‐induced sleep endoscopy (DISE). We define normative values for final propofol infusion rate (Pfinal) during DISE and sedation depth values at Pfinal. Study Design: Retrospective chart review. Setting: Tertiary academic hospital. Methods: A review of patients with obstructive sleep apnea who underwent DISE between 2016 and 2020 was performed. The following patient data were recorded: demographics; DISE procedure details, including Pfinal, time to Pfinal, frequency and cadence of infusion rate changes, depth of sedation as measured by Bispectral Index and SedLine values, and hemodynamics; and polysomnography details including apnea‐hypopnea index severity and minimum oxygen saturation. A mixed linear model adjusted for age and body mass index was performed for the analysis of effects on Pfinal. Pearson correlation coefficients determined the strength of association between depth of sedation measured and pattern of collapse on DISE and Pfinal. Results: There were 246 patients who met inclusion criteria. Pfinal resembled a normal distribution (mean ± SD, 156.44 ± 26.69 mcg/kg/min; median, 150 mcg/kg/min). Analysis demonstrated that Pfinal was influenced by male sex, current smoker status, time to Pfinal, and number of propofol dose changes (P <.05). Depth of sedation categories measured differently between Bispectral Index and SedLine (55‐65 vs 45‐55, P <.001). The pattern including severity of collapse on DISE was not associated with Pfinal (P >.05). No patients required intra‐ or postoperative respiratory support beyond oxygen via nasal canula. Conclusion: We describe a propofol slow‐infusion DISE protocol that demonstrates safe and reproducible outcomes. [ABSTRACT FROM AUTHOR]

Objective: To further demonstrate sleep endoscopy's utility in improving surgical outcomes for pediatric OSA. Methods: This is a retrospective review of surgically naïve patients <18 years old with diagnosed moderate–severe OSA who underwent DISE at the time of initial sleep surgery. Patients included in final analysis had both preoperative and postoperative polysomnograms. Surgical success was defined as an oAHI decrease by at least one diagnostic category. Residual OSA was defined as any patient with postoperative oAHI >1. Results: A total of 106 patients had preoperative and postoperative polysomnograms. Patients with comorbidities comprised 53.8% of the group. Average BMI% was 88.2, with 75.5% classified as obese. The most common area of collapse was the base of tongue, occurring in 32.1% of patients. There was a statistically significant decrease from the mean preoperative oAHI of 29.7 to the mean postoperative oAHI of 6.6 (p < 0.001). Surgical success occurred in 76.4% of patients. A postoperative oAHI of <5 was achieved in 57.7% of patients with moderate or severe OSA. The average BMI% of patients who met surgical success was 86.4, while the average BMI% of patients who did not was 90.8. A postoperative oAHI of <5 was achieved in 68.4% of patients with a BMI% < 85, compared with 55.2% of patients with a BMI% ≥ 85. Conclusion: This study supports the utilization of DISE during initial surgery for severe sleep apnea in the pediatric population. It was found to effectively aid in significantly reducing surgically naïve patients' mean oAHI. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

PURPOSE: The aim of our retrospective study is evaluating the effectiveness of barbed repositioning pharyngoplasty (BRP) in a consecutive cohort of patients and assessing its impact on positional indexes in order to potentially identify specific obstructive sleep apnea (OSA) phenotypes for patients who might benefit more significantly from this intervention. METHODS: A single-center retrospective study with baseline and follow-up type III sleep tests evaluating the Apnea Hypopnea Index (AHI), supine AHI, non-supine AHI, oxygen desaturation index (ODI), mean SaO2, percentage of time spent at SaO2 below 90% (CT90), and lowest oxygen saturation (LOS) were performed. The patients were then divided into groups according to Sher's criteria and Amsterdam Positional OSA Classification (APOC). Parametric and non-parametric tests and univariate and multivariate analyses were conducted. RESULTS: The study finally included 47 patients. The statistical analysis showed significant improvement in AHI, supine AHI, non-supine AHI, and ODI after surgery. The linear regression showed that high values of baseline AHI, AHI supine, and AHI non supine predict more significant postoperative reductions in AHI, AHI supine, and AHI non supine, respectively. Therapeutic success was achieved in 22 patients out of 47. The logistic regression did not find any independent risk factors for success. The most significant reduction in AHI, supine AHI, and non-supine AHI was observed in the APOC 3 group while the APOC 1 patients experience a substantially lower improvement. CONCLUSIONS: BRP appears to be an effective surgical procedure for the treatment of OSA. The non-positional patients might benefit more from BRP in comparison with positional patients. Moreover, OSA severity should not be considered an absolute contra-indication for this surgical procedure. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea syndrome (OSAS) is a common but underdiagnosed condition with significant health and economic implications for society. Inflammatory mediators are proposed to be associated with the presence and severity of OSAS and contribute to morbidity and mortality. This paper details a prospective non-randomized case control study of a cohort of subjects, who underwent surgical treatment of OSAS and were enrolled to assess the sleep parameters and blood levels of selected inflammatory markers at pre-operative and post-operative time points, also comparing them to the levels in a control group. A total of 25 study subjects and 18 control subjects were enrolled. Median values and interquartile range (IQR) of the apnea–hypopnea index (AHI) in the study group pre-operatively and post-operatively were 34 (18.5–45.5) and 13.3 (7.5–27.3), while in the control group 1.4 (1.0–2.1) per hour. The mean (IQR) hs-CRP levels (mg/L) were 1.782 (0.941–5.594) and 1.980 (0.990–5.445) in the study group, pre-operatively and post-operatively, respectively, while 0.891 (0.767–1.436) in the control group. The mean (IQR) TNF-α levels (pg/mL) were 7.999 (6.137–9.216) and 6.614 (5.534–7.460) pre-and post-operatively, respectively, and were 6.000 (5.026–6.823) in the control group. Results demonstrated that both inflammatory markers, hs-CRP and TNF-α, are higher in subjects with OSAS compared to the controls, and their levels decrease, but are still higher than the controls, after successful surgical treatment. Further analysis including the body mass index and age demonstrated that these changes were significant for TNF-α, but not hs-CRP. [ABSTRACT FROM AUTHOR]

Objective: As a first line treatment for pediatric obstructive sleep-disordered breathing (SDB), adenotonsillectomy (AT) has been shown to confer physiologic and neurocognitive benefits to a child. However, there is a scarcity of data on how homework performance is affected postoperatively. Our objective was to evaluate the impact of AT on homework performance in children with SDB. Methods: Children in grades 1 to 8 undergoing AT for SDB based on clinical criteria with or without preoperative polysomnography along with a control group of children undergoing surgery unrelated to the treatment of SDB were recruited. The primary outcome of interest was the differential change in homework performance between the study group and control at follow-up as measured by the validated Homework Performance Questionnaire (HPQ-P). Adjustments were made for demographics and Pediatric Sleep Questionnaire (PSQ) scores. Results: 116 AT and 47 control subjects were recruited, and follow-up data was obtained in 99 AT and 35 control subjects. There were no significant differences between the general (total) HPQ-P scores and subscale scores between the AT and control subjects at entry and there were no significant differences in the change scores (follow-up minus initial scores) between the groups. Regression modeling also demonstrated that there were no group (AT vs control) by time interactions that predicted differential improvements in the HPQ-P (P >.10 for each model) although initial PSQ score was a significant predictor of lower HPQ-P scores for all models. Conclusions: Children with SDB experienced improvement in HPQ-P scores postoperatively, but the degree of change was not significant when compared to controls. Further studies incorporating additional educational metrics are encouraged to assess the true scholastic impact of AT in children with SDB. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the safety and efficacy of a novel technique for transoral tongue suspension (TOTS) in obstructive sleep apnea (OSA) patients. Material and Methods: The retrospective study enrolled 24 consecutive OSA patients (21 males; average age, 43 years; average apnea–hypopnea index (AHI), 42.2 event/h; average body mass index (BMI), 25.7 kg/m2) with tongue obstruction confirmed by drug-induced sleep endoscopy. All patients received TOTS as the main procedure in conjunction with uvulopalatopharyngoplasty (UPPP). Key procedures of TOTS included a transoral sublabial approach, drilling two holes on the mandible, passing the polypropylene through the hole to the tongue base using a suture passer and returning the polypropylene through loop traction, and tying the polypropylene to the mandible. Lingual tonsil ablation (n = 8) was also implemented in hypertrophic lingual tonsils (grades III and IV). Results: The operation time for TOTS was around 30 min. No wound bleeding or airway compromise occurred throughout the postoperative period. Minor complications were temporary and included swelling of the tongue, numbness of the lower incisor, and sublabial wound dehiscence (n = 2). The quality of life improved significantly in the patients' subjective daytime sleepiness according to the Epworth Sleepiness Scale (11.4 ± 3.2 vs. 5.7 ± 1.6, p < 0.001). The objective parameters of OSA also improved significantly in the apnea/hypopnea index (42.2 ± 21.8 vs. 19.5 ± 16.2, p < 0.001), minimal oxygen saturation (77.1 ± 12.2 vs. 81.7 ± 8.1, p = 0.026), and snoring index (207 ± 141 vs. 101 ± 91, p = 0.03). Conclusions: The demonstrated TOTS showed its advantage in low morbidity with a scarless exterior and easy performance with free availability in treating adult OSA patients with tongue obstruction. TOTS combined with UPPP significantly improved AHI and daytime sleepiness. TOTS can be implemented with lingual tonsillectomy to achieve both stabilization of the tongue and widening of hypopharyngeal airway. [ABSTRACT FROM AUTHOR]

Background: This first prospective study evaluates the efficacy and safety of single-port transoral robotic surgery (SP TORS) for tongue base resection (TBR) in obstructive sleep apnea (OSA) patients., Methods: A single-center, single-surgeon clinical investigation enrolled 25 subjects from April 2021 to September 2022. Pre- and postsurgery polysomnography reports and standardized sleep quality assessments were collected. Surgical parameters and complications were documented., Results: According to Sher's success criteria (50% reduction in AHI and AHI < 20), the success rate was 76% (19/25 patients). Preoperative AHI decreased from 58.56 ± 26.40 to 18.19 ± 22.02 postsurgery. Symptoms such as foreign body sensation and taste dysfunction improved within 3 months. Major complications, including hemorrhage, occurred in two patients (8%)., Conclusions: SP TORS TBR effectively manages OSA, significantly improving AHI outcomes and safety. Its precision and targeted tissue removal highlight its advantages over traditional methods, warranting further clinical investigation. Traial Registration: ClinicalTrials.gov identifier: NCT04795817., (© 2024 Wiley Periodicals LLC.)

Mean disease alleviation measures the effectiveness of Obstructive Sleep Apnea (OSA) treatments. It combines a patient's adherence to treatment normalized to their total sleep time and the treatment's efficacy as determined by the change in the apnea-hypopnea index. This metric fails to capture the patient's OSA-related symptoms, which are a key component and, in some cases, the primary component, of determining response to treatment. We propose an enhanced metric called three-dimensional mean disease alleviation (3D-MDA), which incorporates the symptom response to better reflect the true treatment impact. RESULTS: The proposed 3D-MDA metric aims to provide a more comprehensive assessment of OSA treatment effectiveness by integrating the subjective impact, therapy adherence, and objective efficacy. Further, 3D-MDA is adaptable over time as the optimal metrics for these categories continue to evolve., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Thomas Kaffenberger reports a relationship with Inspire Medical Systems Inc that includes: consulting or advisory. Thomas Kaffenberger reports a relationship with Nyxoah SA that includes: consulting or advisory. Thomas Kaffenberger reports a relationship with Cryosa medical that includes: funding grants. Ryan Soose reports a relationship with Cryosa Medical that includes: consulting or advisory. Ryan Soose reports a relationship with XII Medical that includes: consulting or advisory. Ryan Soose reports a relationship with Inspire Medical Systems Inc that includes: consulting or advisory and funding grants. Patrick Strollo reports a relationship with Inspire Medical Systems Inc that includes: consulting or advisory. Patrick Strollo reports a relationship with XII Medical that includes: consulting or advisory. Patrick Strollo reports a relationship with Restora that includes: consulting or advisory. Patrick Strollo reports a relationship with Cryosa Medical that includes: consulting or advisory. Patrick Strollo reports a relationship with Somnomed that includes: consulting or advisory. Patrick Strollo reports a relationship with ZOLL Medical Corporation that includes: consulting or advisory. Patrick Strollo reports a relationship with Itamar-Medical Inc. That includes: consulting or advisory. Patrick Strollo reports a relationship with ResMed that includes: consulting or advisory. Patrick Strollo reports a relationship with Emmi systems that includes: consulting or advisory. Patrick Strollo reports a relationship with WhisperSom that includes: consulting or advisory. Patrick Strollo reports a relationship with Apnimed Inc that includes: consulting or advisory. Patrick Strollo reports a relationship with Philips Respironics Ltd that includes: consulting or advisory. Patrick Strollo reports a relationship with Belluscura LLC that includes: board membership. Olivier Vanderveken reports a relationship with Cochlear Ltd that includes: funding grants. Olivier Vanderveken reports a relationship with MED-EL Electromedical Equipment that includes: funding grants. Olivier Vanderveken reports a relationship with Inspire Medical Systems Inc that includes: consulting or advisory and funding grants. Olivier Vanderveken reports a relationship with Nyxoah SA that includes: funding grants. Olivier Vanderveken reports a relationship with Philips that includes: funding grants. Olivier Vanderveken reports a relationship with ProSomnus that includes: funding grants. Olivier Vanderveken reports a relationship with SomnoMed that includes: consulting or advisory and funding grants. Olivier Vanderveken reports a relationship with GSK that includes: consulting or advisory. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Objective: This study aimed to describe trends in opioid prescriptions among US sleep surgeons between 2013 and 2021 via a retrospective analysis conducted using publicly available data., Methods: Utilizing the CMS part D database, we analyzed data from 82 sleep surgeons, focusing on metrics including number of opioid beneficiaries and claims, opioid cost, and opioid day supply per beneficiary. We employed statistical methods including ANOVA, t-tests, Fisher's exact test with Monte Carlo Simulation, and regression models., Results: There were no significant changes in the number of opioid claims (p = 0.782) or beneficiaries per provider (p = 0.590) nor was there a decrease in opioid day supply per beneficiary (p = 0.489) over time. Surgeons who graduated residency before 2000 prescribed significantly more opioids over the course of the study period compared to those graduating after 2000 with higher opioid day supply per beneficiary (13.34 vs. 7.42, p < 0.001), higher opioid beneficiaries per provider (21.62 vs. 19.36, p = 0.028), and higher opioid claims per provider (30.30 vs. 21.78, p < 0.001). A significant annual decrease in opioid cost per beneficiary (ANOVA, p = 0.006) was noted., Conclusions: This study illuminates a significant impact of provider years in practice on opioid prescribing trends, alongside a decreasing trend in opioid cost per beneficiary. Despite the evolving paradigm emphasizing opioid reduction and evidence of decreasing opioid prescriptions in other otolaryngology subspecialties, our findings depict that opioid prescriptions among sleep surgeons remained stable from 2013 to 2021., Level of Evidence: 3 Laryngoscope, 134:4810-4817, 2024., (© 2024 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: Multilevel airway surgery for obstructive sleep apnea/hypopnea syndrome (OSA) has benefits in improving sleep quality, but its effect on polysomnography (PSG) and 6-minute walk test (6MWT) parameters, including walking distance and cardiopulmonary performance, in patients with poor pre-operative cardiopulmonary performance remains understudied, which should be further investigated., Methods: This prospective pilot study enrolled 27 consecutive OSA patients with poor pre-operative 6MWT results. All patients received multilevel OSA surgery, and the alterations of sleep parameters and 6MWT profiles were studied. The pre- and post-operative values of polysomnographic data and 6MWT profiles were analyzed using the Wilcoxon signed-rank tests. The relationships among changes of the indices of PSG and 6MWT were further investigated with the Spearman's correlations., Results: After surgery, the sleep parameters and certain cardiopulmonary indices improved. When analyzing the correlations among changes of the indices of PSG and 6MWT, the improvement of daytime sleepiness (with ESS) was found related to farther walking distance (ρ=-0.414, p = 0.032) and higher percentage of "distance/target distance" (ρ=-0.435, p = 0.023). Moreover, the change of maximal expiratory pressure was the only index associated with the changes of AHI (apnea/hypopnea index, /hr.; ρ=-0.407, p = 0.035) and AHI in REM (ρ=-0.502, p = 0.009) among the cardiopulmonary performance parameters., Conclusion: This pilot study showed that OSA patients with poor pre-operative cardiopulmonary status undergoing multilevel sleep surgery could experience improvement in the sleep study and 6MWT to some extent. The relatively better walking distance and cardiopulmonary performance after the operation might potentially result from the improvement of daytime sleepiness and better respiration., (Copyright © 2024. Published by Elsevier B.V.)

Placement of the sensing lead can be challenging in obese and Down syndrome patients. This article presents an alteration in technique for its placement for these patient populations. Laryngoscope, 2024., (© 2024 The American Laryngological, Rhinological and Otological Society, Inc.)

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.)

Objective: Obstructive Sleep Apnea (OSA) in children is treated primarily with adenotonsillectomy (AT). When clinical exam demonstrates small tonsils, the success of AT in resolving OSA is uncertain. The purpose of this study is to determine the utility of Drug induced Sleep Endoscopy (DISE) for children with OSA and small tonsils (Brodsky scale 1+) and to identify what obstructive trends exist in this subset of patients and to determine the utility of DISE-directed surgical intervention in patients with small tonsils. Methods: A retrospective chart review was performed for patients who underwent DISE at a tertiary care center over a 2-year period. Inclusion criteria were 1+ tonsils and a positive sleep study. Data collected included DISE findings, BMI, comorbid conditions, and pre-op PSG data. Results: Forty children were included with a mean age of 5.0 years (range 8 months-16 years). Mean preoperative AHI was 5.46 and mean oxygen saturation nadir was 87.1%. The most common contributor to airway obstruction was the adenoid (29 patients, 72.5%), followed by the tongue base or lingual tonsil (21 patients, 52.5%). The palatine tonsils (10 patients, 25.0%), epiglottis (10.0%), or obstruction intrinsic to the larynx (10.0%) were significantly less frequently identified as contributors to OSA when compared to the adenoid (P <.001). The majority of patients had multilevel obstruction (25 patients, 62.5%). Adenoidectomy (27 patients, 67.5%) was the most commonly performed procedure, followed by tonsillectomy (10 patients, 25.0%, P <.001) and tongue base surgery (9 patient 22.5%, P <.001). Conclusion: In this group, small palatine tonsils were infrequently identified as a contributor to airway obstruction and tonsillectomy was avoided in most cases. This study illustrates the utility of DISE as a tool to personalize the surgical management of pediatric patients with OSA and small tonsils on physical exam. [ABSTRACT FROM AUTHOR]

Alternatives to positive airway pressure therapy, including surgery, represent an important area of research. Specifically, predictors of response to surgical therapy remain underdeveloped. Drug-induced sleep endoscopy (DISE) holds promise as a diagnostic tool to identify patient-specific causes of airway collapse. Herein, we present a novel, standardized approach which combines anatomic and physiologic measurements during DISE. Our DISE platform measures airflow, airway compliance, airway collapsibility, and structural drivers of collapse. Taken together, these inputs provide a comprehensive framework to further inform the surgeon in providing personalized care of the patient with obstructive sleep apnea. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) is the most common respiratory disease in the developed world and is commonly treated with positive airway pressure therapy (PAP). Recently, hypoglossal nerve (HNS) has been introduced as alternative treatment for OSA patients with PAP intolerance. We report the initial results with HNS treatment from Spain. Patients with OSA and PAP intolerance were screened for HNS treatment with the Inspire™ system. After implantation and activation, efficacy was evaluated with polysomnography and indication-specific questionnaires. Adherence data was recorded from the stimulation system. 18 patients (51.83 ± 11.64 years, 94% male, mean Body Mass Index 27.94 ± 3.20) received an Inspire™ UAS system and were included for analysis. Mean procedure time was 202.83 ± 64.87 min. and average hospital stay 26.67 ± 7.54 h. Mean Apnea–Hypopnea-Index was reduced by 63.44% (p ≤ 0.0001), while daytime sleepiness improved to a mean ESS score of 6.60 ± 1.25 (p ≤ 0.0001 Therapy response (AHI reduction > 50% and final AHI < 20), was reached in 64.70 and normalization of daytime sleepiness (final ESS score < 10) in 100% of patients. Therapy adherence was 6.32 ± 1.71 h per night. HNS is a safe and leads to effective OSA control and symptom normalization in selected OSA patients with PAP intolerance. Stimulation therapy is well accepted, as demonstrated by high adherence. Implementation of HNS therapy into an OSA program in Spain is feasible with acceptable learning curve and moderate resource utilization. [ABSTRACT FROM AUTHOR]

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Objective: Obstructive sleep apnea (OSA) is a highly prevalent disorder with many treatment modalities, including surgical intervention. While OSA is known to be more prevalent in males and Black Americans, the representation of race and sex in sleep surgery studies is unknown. The aim of this systematic review is to assess the race and sex demographics represented in sleep surgery studies relative to known OSA demographics. Data Sources: PubMed, MEDLINE, and OVID databases. Review Methods: A systematic review was conducted to identify studies published between 2016 and 2020 that investigated sleep outcomes following nonnasal surgical intervention for OSA in adults. Pooled racial, ethnic, and sex data of the enrolled subjects in selected studies were analyzed. Results: The 148 included studies comprised 13,078 patients. Of the 137 studies that reported sex, 84.0% of participants were male, exceeding the population prevalence of OSA in males, which is estimated at 66%. Only 13 studies reported racial/ethnic demographic data. Of these, 87.8% of patients were White. Out of 30 studies of primarily American patients, only 4 reported race demographic data, with an average of 82.8% White participants. Conclusion: There is a racial/ethnic and sex inclusion bias among sleep surgery studies. Future studies should better document the demographics of enrolled participants as well as recruit participants who better represent the demographics of adults with OSA in the general population. [ABSTRACT FROM AUTHOR]