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Chronic kidney disease (CKD) is a major cause of morbidity and mortality in India, with a prevalence estimated at 13-15%. Obstructive sleep apnea (OSA) is an emerging threat, significantly contributing to CKD development. Over 50% of end-stage renal disease (ESRD) patients exhibit OSA symptoms. Co-existing OSA exacerbates CKD through mechanisms such as tissue hypoxia and increased inflammatory mediators, while CKD worsens OSA due to volume overload and respiratory muscle weakening. The pathophysiology involves nocturnal hypoxia causing glomerular hypertension and subsequent renal injury. Treatment options for OSA include behavioral modifications, CPAP therapy, and surgery. CPAP therapy shows potential in improving renal parameters but requires further long-term studies. Dialysis, especially nocturnal hemodialysis, significantly reduces OSA severity and improves oxygen saturation levels. Surgical interventions, while reducing ESRD risk, carry a short-term increased risk of non-cardiovascular mortality. Recognizing and treating OSA in CKD and ESRD patients is crucial to breaking the cycle of mutual exacerbation and improving patient outcomes. This review highlights the pathophysiology and management strategies of the OSA-CKD complex. [ABSTRACT FROM AUTHOR]

The hyoid bone's inferior baseline position in obstructive sleep apnea (OSA) has led to surgical hyoid repositioning (SHR) treatment, yet outcomes vary widely. The influence of baseline hyoid position (BHP; phenotype) and SHR on upper airway (UA) function remains unclear. We aimed to investigate their impact on the UA using computational modeling. A validated finite element model of the rabbit UA was advanced and used to simulate changes in BHP and SHR, alone and in combination. The hyoid was displaced in cranial, caudal, anterior, anterior-cranial, and anterior-caudal directions from 1 to 4 mm. Model outcomes included UA collapsibility, measured using closing pressure (Pclose), cross-sectional area (CSA), and soft tissue mechanics (displacement, stress, and strain). Graded BHP increments increased Pclose for all directions and up to 29%–43% at 4 mm (relative to the original BHP). Anterior-based SHR decreased Pclose (approximately −115% at 4 mm) and increased ΔCSA (approximately +35% at 4 mm). Cranial SHR decreased ΔPclose (−29%), minimally affecting CSA. Caudal SHR increased ΔPclose (+27%) and decreased ΔCSA (−7%). Anterior-cranial and anterior-caudal SHR produced the highest stresses and strains. SHR effects on UA outcomes were dependent on BHP, with more caudal BHPs leading to less effective surgeries. In conclusion, BHP (phenotype) and SHR both alter UA outcomes, with effects dependent on hyoid displacement direction and magnitude. BHP influences the effectiveness of SHR in reducing UA collapsibility. These findings provide further insights into the hyoid's role in UA patency and suggest that considering the hyoid's baseline position and surgical repositioning direction/increment may help improve hyoid surgeries for OSA treatment. NEW & NOTEWORTHY: Using computational modeling, this study directly shows that any shift from the healthy natural hyoid bone position increases upper airway collapsibility. Surgical hyoid repositioning alters upper airway outcomes in a direction- and magnitude-dependent manner, with its effects influenced by the natural hyoid position. Accounting for both the natural hyoid position and individually prescribed surgical repositioning may enhance upper airway stability and improve outcomes in obstructive sleep apnea (OSA) treatment. [ABSTRACT FROM AUTHOR]

Purpose: Patients with syndromic hemifacial microsomia (SHFM) are at risk of obstructive sleep apnea (OSA). The aim of the study was to describe the prevalence of OSA and its management, especially in patients with Goldenhar syndrome (GS). Methods: The respiratory polygraphies and clinical management of 15 patients, aged 2 to 23 years, evaluated at a national reference center, were analyzed. Results: Four (27%) patients had no OSA, 4 (27%) had mild OSA, and 7 (46%), of whom 5 were ≤ 2 years old, had severe OSA. None of the patients had central apneas. Only one patient had alveolar hypoventilation, and another one had nocturnal hypoxemia. Two patients had severe OSA despite prior adenoidectomy or mandibular distraction osteogenesis. Median duration of follow-up was 3.5 years (range 0.5—9 years). None of the patients without OSA or with mild OSA at baseline respiratory polygraphy developed OSA during the follow up. Among the 7 patients with severe OSA, 3 required continuous positive airway pressure or noninvasive ventilation, and one patient required a tracheostomy. Conclusion: In conclusion, patients with SHFM are at high risk of severe OSA at any age, underlining the importance of systematic sleep studies to diagnose and evaluate the severity of OSA. Individualized treatment should be privileged, based on a careful examination of the entire upper airway, taking in account potential associated risk factors. All patients with SHFM should be managed by a pediatric expert multidisciplinary medical/surgical team until the end of post pubertal growth. [ABSTRACT FROM AUTHOR]

A new monitoring protocol for orthognathic surgery for addressing obstructive sleep apnea syndrome in adult patients using bilateral internal ramus distraction (BIRD) followed by Lefort I osteotomy and monitored by HRP is presented. This strategy is part of an outpatient major surgery protocol and includes preoperative 3d virtual planning, followed by surgery under general anesthesia with endoscopic assistance.Following the procedure, patients are typically discharged on the same day, with the vertical lengthening of the mandibular ramus starting after a 5-day period and progressing at a speed of 0.5–1 mm per day over a period of 10–50 days. The process carries on until the negative dental overjet exceeds 10 mm or the apnea-hypopnea index falls beneath 15 events per hour, demonstrating a curative level.Mandibular advancement monitorization based on clinical, polygraphic, or polysomnographic criteria enables the surgeon to meet the individual needs of each patient. The distractors are typically maintained in position for six months following elongation of 10–25 mm to ensure proper consolidation.BIRD followed by LeFort I osteotomy, has demonstrated significant efficacy as a treatment for obstructive sleep apnea syndrome in adult patients, irrespective of the presence of retrognathia. Furthermore, this approach may offer particular advantages for patients with severe cardiovascular disease or diabetes.

Surgical interventions, like barbed reposition pharyngoplasty (BRP), are a valuable alternative for patients with obstructive sleep apnea (OSA) who are unable to tolerate continuous positive airway pressure (CPAP). However, predicting surgical success remains challenging, partly due to the contribution of non-anatomical factors. Therefore, combined medical treatment with acetazolamide, known to stabilize respiratory drive, may lead to superior surgical results. This double-blind, parallel-group randomized controlled trial evaluates the efficacy of acetazolamide as an add-on therapy to BRP in OSA. A total of 26 patients with moderate to severe OSA undergoing BRP were randomized to receive either acetazolamide or placebo post-surgery for 16 weeks. The group who was treated with BRP in combination with acetazolamide showed a reduction in AHI of 69.4%, significantly surpassing the 32.7% reduction of the BRP + placebo group (p < 0.01). The sleep apnea-specific hypoxic burden also decreased significantly in the group who was treated with BRP + acetazolamide (p < 0.01), but not in the group receiving BRP + placebo (p = 0.28). Based on these results, acetazolamide as an add-on therapy following BRP surgery shows promise in improving outcomes for OSA patients, addressing both anatomical and non-anatomical factors. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to obtain a comprehensive view of the risk of developing cancer in patients with obstructive sleep apnea (OSA) and to compare this risk between patients receiving continuous positive airway pressure (CPAP) therapy versus upper airway surgery (UAS). Methods: We used both local data and a global-scale federated data research network, TriNetX, to access electronic medical records, including those of patients diagnosed with OSA from health-care organizations (HCOs) worldwide. We used propensity score matching and the score-matched analyses of data for 5 years of follow-up, Results: We found that patients who had undergone UAS had a similar risk of developing cancer than those who used CPAP [hazard ratio of 0.767 (95% CI 0.559–1.053; P = 0.100)]. Conclusion: Analysis of the large data sets collected from HCOs in Europe and globally lead us to conclude that in patients with OSA, neither CPAP nor UAS were associated with the development of cancer better than in non-treated patients. [ABSTRACT FROM AUTHOR]

Abstract Obstructive sleep apnea (OSA) is associated with multiple chronic comorbidities with treatments including continuous positive airway pressure (CPAP), upper airway surgery (UAS), and hypoglossal nerve stimulation (HNS). Given the complexity of the condition and multiple treatment options, there is an ongoing debate to determine the best management. O’Connor-Reina et al. recently published a paper titled “Risk of diabetes in patients with sleep apnea: comparison of surgery versus CPAP in a long-term follow-up study.” In their study, the authors stated that OSA patients who received surgery had a 50% less chance of developing diabetes compared to patients who only received CPAP treatment. However, we would like to point out some limitations that warrant attention and caution interpretation of the findings by physicians and patients.

The American Thoracic Society Sleep Core Curriculum updates clinicians on important sleep topics, presented during the annual meeting, and appearing in summary here. This year's sleep core theme is sleep-disordered breathing and its management. Topics range from pathophysiological mechanisms for the association of obstructive sleep apnea (OSA) and metabolic syndrome, surgical modalities of OSA treatment, comorbid insomnia and OSA, central sleep apnea, and sleep practices during a pandemic. OSA has been associated with metabolic syndrome, independent of the role of obesity, and the pathophysiology suggests a role for sleep fragmentation and intermittent hypoxia in observed metabolic outcomes. In specific patient populations, surgical treatment modalities for OSA have demonstrated large reductions in objective disease severity compared with no treatment and may facilitate adherence to positive airway pressure treatment. Patient-centered approaches to comorbid insomnia and sleep apnea include evaluating for both OSA and insomnia simultaneously and using shared-decision making to determine the order and timing of positive airway pressure therapy and cognitive behavioral therapy for insomnia. The pathophysiology of central sleep apnea is complex and may be due to the loss of drive to breathe or instability in the regulatory pathways that control ventilation. Pandemic-era sleep practices have evolved rapidly to balance safety and sustainability of care for patients with sleep-disordered breathing.

This study aimed to obtain a comprehensive view of the risk of developing diabetes in patients with obstructive sleep apnea (OSA) and to compare this risk between patients receiving continuous positive airway pressure (CPAP) therapy versus upper airway surgery (UAS). We used local and the global-scale federated data research network TriNetX to obtain access to electronic medical records, including those for patients diagnosed with OSA, from health-care organizations (HCOs) worldwide. Using propensity score matching and the score-matched analyses of data for 5 years of follow-up, we found that patients who had undergone UAS had a lower risk of developing diabetes than those who used CPAP (risk ratio 0.415, 95% confidence interval (CI) 0.349–0.493). The risk for newly diagnosed diabetes patients showed a similar pattern (hazard ratio 0.382; 95% CI 0.317–0.459). Both therapies seem to protect against diabetes (Risk 0.081 after UAS vs. 0.195 after CPAP). Analysis of the large data sets collected from HCOs in Europe and globally lead us to conclude that, in patients with OSA, UAS can prevent the development of diabetes better than CPAP. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) is associated with multiple chronic comorbidities with treatments including continuous positive airway pressure (CPAP), upper airway surgery (UAS), and hypoglossal nerve stimulation (HNS). Given the complexity of the condition and multiple treatment options, there is an ongoing debate to determine the best management. O'Connor-Reina et al. recently published a paper titled "Risk of diabetes in patients with sleep apnea: comparison of surgery versus CPAP in a long-term follow-up study." In their study, the authors stated that OSA patients who received surgery had a 50% less chance of developing diabetes compared to patients who only received CPAP treatment. However, we would like to point out some limitations that warrant attention and caution interpretation of the findings by physicians and patients. [ABSTRACT FROM AUTHOR]

Purpose: Predictors for the outcome of uvulopalatopharyngoplasty with and without tonsillectomy (UPPP ± TE) in sleep-disordered breathing have not been fully established. This study investigates tonsil grade, volume, and preoperative examination in predicting radiofrequency UPP ± TE outcomes. Methods: All patients undergoing radiofrequency UPP with tonsillectomy if tonsils were present between 2015 and 2021 were retrospectively analyzed. Patients underwent a standardized clinical examination, including Brodsky palatine tonsil grade from 0 to 4. Preoperatively and 3 months after surgery, sleep apnea testing was performed using respiratory polygraphy. Questionnaires were administered assessing daytime sleepiness using the Epworth Sleepiness Scale (ESS) and snoring intensity on a visual analog scale. Tonsil volume was measured intraoperatively using water displacement. Results: The baseline characteristics of 307 patients and the follow-up data of 228 patients were analyzed. Tonsil volume increased by 2.5 ml (95% CI 2.1–2.9 ml; P < 0.001) per tonsil grade. Higher tonsil volumes were measured in men, younger patients, and patients with higher body mass indices. The preoperative apnea–hypopnea index (AHI) and AHI reduction strongly correlated with tonsil volume and grade, whereas postoperative AHI did not. The responder rate increased from 14% to 83% from tonsil grade 0 to 4 (P < 0.01). ESS and snoring were significantly reduced after surgery (P < 0.01), but the reduction was not influenced by tonsil grade or volume. No other preoperative factor other than tonsil size could predict surgical outcomes. Conclusions: Tonsil grade and intraoperatively measured volume correlate well and predict the reduction of AHI, while they are not predictive of ESS and snoring response after radiofrequency UPP ± TE. [ABSTRACT FROM AUTHOR]

Study objectivesControversy exists as to whether elevated loop gain is a cause or consequence of obstructive sleep apnea (OSA). Upper airway surgery is commonly performed in Asian patients with OSA who have failed positive airway pressure therapy and who are thought to have anatomical predisposition to OSA. We hypothesized that high loop gain would decrease following surgical treatment of OSA due to reduced sleep apnea severity.MethodsPolysomnography was performed preoperatively and postoperatively to assess OSA severity in 30 Chinese participants who underwent upper airway surgery. Loop gain was calculated using a validated clinically-applicable method by fitting a feedback control model to airflow.ResultsPatients were followed up for a median (interquartile range) of 130 (62, 224) days after surgery. Apnea-hypopnea index (AHI) changed from 60.8 (33.7, 71.7) to 18.4 (9.9, 42.5) events/h (P < .001). Preoperative and postoperative loop gain was 0.70 (0.58, 0.80) and 0.53 (0.46, 0.63) respectively (P < .001). There was a positive association between the decrease in loop gain and the improvement of AHI (P = .025).ConclusionsHigh loop gain was reduced by surgical treatment of OSA in our cohort. These data suggest that elevated loop gain may be acquired in OSA and may provide mechanistic insight into improvement in OSA with upper airway surgery.Clinical trial registrationRegistry: ClinicalTrials.gov, Title: The Impact of Sleep Apnea Treatment on Physiology Traits in Chinese Patients With Obstructive Sleep Apnea, Identifier: NCT02696629, URL: https://clinicaltrials.gov/show/NCT02696629.

Introduction: This paper describes the development of "Swedish Guidelines for OSA treatment" and the underlying managed care process. The Apnea Hypopnea Index (AHI) is traditionally used as a single parameter for obstructive sleep apnea (OSA) severity classification, although poorly associated with symptomatology and outcome. We instead implement a novel matrix for shared treatment decisions based on available evidence. Methods: A national expert group including medical and dental specialists, nurses, and patient representatives developed the knowledge-driven management model. A Delphi round was performed amongst experts from all Swedish regions (N = 24). Evidence reflecting treatment effects was extracted from systematic reviews, meta-analyses, and randomized clinical trials. Results: The treatment decision in the process includes a matrix with five categories from a "very weak"" to "very strong" indication to treat, and it includes factors with potential influence on outcome, including (A) OSA-related symptoms, (B) cardiometabolic comorbidities, (C) frequency of respiratory events, and (D) age. OSA-related symptoms indicate a strong incitement to treat, whereas the absence of symptoms, age above 65 years, and no or well-controlled comorbidities indicate a weak treatment indication, irrespective of AHI. Conclusions: The novel treatment matrix is based on the effects of treatments rather than the actual frequency of respiratory events during sleep. A nationwide implementation of this matrix is ongoing, and the outcome is monitored in a prospective evaluation by means of the Swedish Sleep Apnea Registry (SESAR). [ABSTRACT FROM AUTHOR]

Background: Surgical hyoid bone repositioning procedures are being performed to treat obstructive sleep apnea (OSA), though outcomes are highly variable. This is likely due to lack of knowledge regarding the precise influence of hyoid bone position on upper airway patency. The aim of this study is to determine the effect of surgical hyoid bone repositioning on upper airway collapsibility. Methods: Seven anaesthetized, male, New Zealand White rabbits were positioned supine with head/neck position controlled. The rabbit's upper airway was surgically isolated and hyoid bone exposed to allow manipulation of its position using a custom-made device. A sealed facemask was fitted over the rabbit's snout, and mask/upper airway pressures were monitored. Collapsibility was quantified using upper airway closing pressure (Pclose). The hyoid bone was repositioned within the mid-sagittal plane from 0 to 5mm (1mm increments) in anterior, cranial, caudal, anterior-cranial (45°) and anterior-caudal (45°) directions. Results: Anterior displacement of the hyoid bone resulted in the greatest decrease in Pclose amongst all directions (p = 0.002). Pclose decreased progressively with each increment of anterior hyoid bone displacement, and down by -4.0 ± 1.3 cmH2O at 5 mm. Cranial and caudal hyoid bone displacement did not alter Pclose (p > 0.35). Anterior-cranial and anteriorcaudal hyoid bone displacements decreased Pclose significantly (p < 0.004) and at similar magnitudes to the anterior direction (p > 0.68). Conclusion: Changes in upper airway collapsibility following hyoid bone repositioning are both direction and magnitude dependent. Anterior-based repositioning directions have the greatest impact on reducing upper airway collapsibility, with no effect on collapsibility by cranial and caudal directions. Findings may have implications for guiding and improving the outcomes of surgical hyoid interventions for the treatment of OSA. [ABSTRACT FROM AUTHOR]

Study Objectives: Multilevel upper airway surgery is effective for some patients with obstructive sleep apnea (OSA), but prediction the response to surgery remains a challenge. The underlying endotypes of OSA include upper airway collapsibility, muscle compensation, loop gain, and the arousal threshold. This study aimed to explore the effect of surgery on polysomnography (PSG)-derived OSA endotypes and establish a surgical response prediction model., Methods: Our study included 54 Chinese patients with OSA who underwent multilevel upper airway surgery. Participants underwent PSG before and after surgery with a median follow-up time of 6.5 months. Using AHIBaseline/AHIpost-surgery ≥ 2 and AHIpost-surgery < 10 events/h as criteria, participants were classified as surgery responders and non-responders. The surgical success rate was 26%. These endotypic traits were derived from a standard PSG data by validated methods., Results: The surgery altered both anatomical and non-anatomical endotypic traits, including increased Vpassive (baseline VS post-surgery: 51.5[18.7-84.2] VS 86.8 [67.4-93.7] %Veupnea, p<0.001), decreased loop gain (baseline VS post-surgery: 0.7 [0.7-0.8] VS 0.6[0.5-0.6]; p<0.001), and a higher arousal threshold (baseline VS post-surgery: 202.9[183.7-222.0] VS 160.7[143.9-177.4] %Veupnea; p<0.001). However, it did not significantly affect muscle compensation. Fully adjusted logistic regression analyses indicated that a favorable response to surgery was independently associated with a lower LG (OR [CI 95%], 0.1[0.0-0.5], p= 0.032). In patients with improved muscle compensation or a more collapsible airway (lower Vpassive), a lower loop gain was more strongly indicative of success. However, when muscle compensation was lower or collapsibility was less severe (higher Vpassive), a lower loop gain was less predictive of success., Conclusions: This study demonstrated that multilevel upper airway surgery altered both anatomical and non-anatomical endotypes in Chinese patients with OSA. An endotype based regression model may meaningfully predict surgical success., (© The Author(s) 2025. Published by Oxford University Press on behalf of Sleep Research Society.)

Background: Surgical hyoid bone repositioning procedures are being performed to treat obstructive sleep apnea (OSA), though outcomes are highly variable. This is likely due to lack of knowledge regarding the precise influence of hyoid bone position on upper airway patency. The aim of this study is to determine the effect of surgical hyoid bone repositioning on upper airway collapsibility.Methods: Seven anaesthetized, male, New Zealand White rabbits were positioned supine with head/neck position controlled. The rabbit’s upper airway was surgically isolated and hyoid bone exposed to allow manipulation of its position using a custom-made device. A sealed facemask was fitted over the rabbit’s snout, and mask/upper airway pressures were monitored. Collapsibility was quantified using upper airway closing pressure (Pclose). The hyoid bone was repositioned within the mid-sagittal plane from 0 to 5 mm (1 mm increments) in anterior, cranial, caudal, anterior-cranial (45°) and anterior-caudal (45°) directions.Results: Anterior displacement of the hyoid bone resulted in the greatest decrease in Pclose amongst all directions (p = 0.002). Pclose decreased progressively with each increment of anterior hyoid bone displacement, and down by −4.0 ± 1.3 cmH2O at 5 mm. Cranial and caudal hyoid bone displacement did not alter Pclose (p > 0.35). Anterior-cranial and anterior-caudal hyoid bone displacements decreased Pclose significantly (p < 0.004) and at similar magnitudes to the anterior direction (p > 0.68).Conclusion: Changes in upper airway collapsibility following hyoid bone repositioning are both direction and magnitude dependent. Anterior-based repositioning directions have the greatest impact on reducing upper airway collapsibility, with no effect on collapsibility by cranial and caudal directions. Findings may have implications for guiding and improving the outcomes of surgical hyoid interventions for the treatment of OSA.

Background and objective: Upper airway surgery for obstructive sleep apnoea (OSA) is an alternative treatment for patients who are intolerant of continuous positive airway pressure (CPAP). However, upper airway surgery has variable treatment efficacy with no reliable predictors of response. While we now know that there are several endotypes contributing to OSA (i.e., upper airway collapsibility, airway muscle response/compensation, respiratory arousal threshold and loop gain), no study to date has examined: (i) how upper airway surgery affects all four OSA endotypes, (ii) whether knowledge of baseline OSA endotypes predicts response to surgery and (iii) whether there are any differences when OSA endotypes are measured using the CPAP dial‐down or clinical polysomnographic (PSG) methods. Methods: We prospectively studied 23 OSA patients before and ≥3 months after multilevel upper airway surgery. Participants underwent clinical and research PSG to measure OSA severity (apnoea–hypopnoea index [AHI]) and endotypes (measured in supine non‐rapid eye movement [NREM]). Values are presented as mean ± SD or median (interquartile range). Results: Surgery reduced the AHITotal (38.7 [23.4 to 79.2] vs. 22.0 [13.3 to 53.5] events/h; p = 0.009). There were no significant changes in OSA endotypes, however, large but variable improvements in collapsibility were observed (CPAP dial‐down method: ∆1.9 ± 4.9 L/min, p = 0.09, n = 21; PSG method: ∆3.4 [−2.8 to 49.0]%Veupnoea, p = 0.06, n = 20). Improvement in collapsibility strongly correlated with improvement in AHI (%∆AHISupineNREM vs. ∆collapsibility: p < 0.005; R2 = 0.46–0.48). None of the baseline OSA endotypes predicted response to surgery. Conclusion: Surgery unpredictably alters upper airway collapsibility but does not alter the non‐anatomical endotypes. There are no baseline predictors of response to surgery. This is the first study to measure how upper airway surgery affects all four obstructive sleep apnoea (OSA) endotypes using both the continuous positive airway pressure dial‐down and clinical polysomnographic methods. Using either method, surgery unpredictably altered the upper airway anatomy/collapsibility and did not alter the non‐anatomical endotypes. None of the baseline OSA endotypes were able to predict the response to surgery. See relatedEditorial [ABSTRACT FROM AUTHOR]

Study objectivesTo test whether the integration of both anatomical and nonanatomical parameters (ventilatory control, arousal threshold, muscle responsiveness) in a physiology-based model will improve the ability to predict outcomes after upper airway surgery for obstructive sleep apnea (OSA).MethodsIn 31 patients who underwent upper airway surgery for OSA, loop gain and arousal threshold were calculated from preoperative polysomnography (PSG). Three models were compared: (1) a multiple regression based on an extensive list of PSG parameters alone; (2) a multivariate regression using PSG parameters plus PSG-derived estimates of loop gain, arousal threshold, and other trait surrogates; (3) a physiological model incorporating selected variables as surrogates of anatomical and nonanatomical traits important for OSA pathogenesis.ResultsAlthough preoperative loop gain was positively correlated with postoperative apnea-hypopnea index (AHI) (P = .008) and arousal threshold was negatively correlated (P = .011), in both model 1 and 2, the only significant variable was preoperative AHI, which explained 42% of the variance in postoperative AHI. In contrast, the physiological model (model 3), which included AHIREM (anatomy term), fraction of events that were hypopnea (arousal term), the ratio of AHIREM and AHINREM (muscle responsiveness term), loop gain, and central/mixed apnea index (control of breathing terms), was able to explain 61% of the variance in postoperative AHI.ConclusionsAlthough loop gain and arousal threshold are associated with residual AHI after surgery, only preoperative AHI was predictive using multivariate regression modeling. Instead, incorporating selected surrogates of physiological traits on the basis of OSA pathophysiology created a model that has more association with actual residual AHI.CommentaryA commentary on this article appears in this issue on page 1023.Clinical trial registrationClinicalTrials.Gov; Title: The Impact of Sleep Apnea Treatment on Physiology Traits in Chinese Patients With Obstructive Sleep Apnea; Identifier: NCT02696629; URL: https://clinicaltrials.gov/show/NCT02696629.

The aim of this study was to evaluate the clinical efficacy of maxillomandibular advancement (MMA) for obstructive sleep apnea (OSA) patients with a percentage of central and mixed apnea index in the total apnea−hypopnea index (CMAI%) ≧25%. Patients treated with MMA for OSA were retrospectively evaluated for baseline and postoperative patient data and polysomnographic results. The pre- and postoperative obstructive, central and mixed apnea parameters were compared. Of the included 78 patients, 21 patients (27%) presented with CMAI% ≧25% (median CMAI%, 49.1%; 35.9–63.8) prior to MMA. In 67% of these cases, MMA resulted in CMAI% <25 (median CMAI%, 6.1%; 2.1–8.9) and significantly improved the apnea−hypopnea index (AHI) (p < 0.001), the lowest oxyhemoglobin saturation (p < 0.001), central and mixed apnea index (p < 0.001), percentage of central and mixed apneas of total AHI (p = 0.004), central apnea index (p < 0.001), and mixed apnea index (p < 0.001). CMAI% ≧25% emerged in 25% of patients after MMA (median CMAI%, 49.1%; 35.9–63.8). Within the undeniable limitations of the study, it seems that the presence of CMAI% ≧25% should not be regarded as a contraindication for MMA in OSA patients. [ABSTRACT FROM AUTHOR]

Objectives: To perform an updated systematic review for determining the surgical success rate of multilevel upper airway surgery for patients with obstructive sleep apnea/hypopnea syndrome (OSA).Methods: A systematic review was performed to identify English-language studies that evaluated the treatment of adult OSA patients with multilevel OSA surgery up to January, 2018. We used polysomnography as a metric of treatment success. Articles were only included if the surgery intervention involved at least two of the frequently involved anatomic sites: nose, oropharynx and hypopharynx. Eighty-seven studies fit the inclusion criteria and a meta-analysis was performed to determine the overall success.Results: The meta-analysis included 3931 subjects with a mean age of 46.1 years. The originally reported success rate in the included literature was 59.9%. A meta-analysis was performed to redefine the success rate to be consistent with the commonly agreed upon criteria - namely "a reduction in apnea/hypopnea index (AHI, /hr.) of 50% or more and an AHI of less than 20". The recalculated success rate was 60.2%. Standard meta-analytic techniques for combining p-values between studies after weighting for sample size found significant improvements in AHI, apnea index, % of rapid eye movement sleep, lowest saturation of oxygen (%), and Epworth Sleepiness Scale.Conclusion: This study shows the significant improvement of treatment outcomes with multilevel surgery for OSA patients. [ABSTRACT FROM AUTHOR]

Purpose: The aim was to compare the outcomes of upper airway stimulation (Stim) and other upper airway surgical procedures (Surg) in the treatment of obstructive sleep apnea (OSA). Methods: Data sources included PubMed, Ovid MEDLINE, Cochrane Library, Web of Science, Scopus, and reference lists. Relevant articles were identified from various databases according to the PRISMA guidelines. Results: Five articles with a total of 990 patients were included. The mean cure rates in the Stim group and the Surg group was 63% and 22%, and the mean success rates was 86% and 51% which were higher in the Stim group (p < 0.001). The apnea–hypopnea index reduction was -23.9 events/ hour (MD, 95% CI -25.53, -22.29) in the Stim group and -15.5 events/hour (MD, 95% CI -17.50, -13.45) in the Surg group which was greater in the Stim group (P < 0.001). Epworth Sleepiness Scale decreased -4.9 (MD, 95% CI -5.45, -4.32) in the Stim group and -5.1 (MD 95% CI -5.88, -4.37) in the Surg group without significant difference between the groups (P = 0.62). Oxygen saturation nadir improvement was 8.5% (MD 95% CI 7.05%, 9.92%) in the Stim group and 2.2% (MD 95% CI—0.22%, 4.58%) in the Surg group which was higher in the Stim group (P < 0.001). Hospital stay and readmission rate were lower in the Stim group. The timing of follow-up ranged from 2 to 13 months. Conclusion: Upper airway stimulation provides improved objective and similar subjective outcomes compared to other upper airway surgical procedures for selected patients with moderate to severe OSA with difficulty adhering to CPAP treatment. However, further studies are essential to confirm outcomes in the long term. [ABSTRACT FROM AUTHOR]

Purpose: Although upper airway surgery in selected patients with obstructive sleep apnea (OSA) has been shown to be beneficial, its long-term effects have been questioned. The main objective was to evaluate whether results following surgery remain stable over time, both in objective and subjective terms. As a secondary aim, such stability was also measured in relation with the type of surgery performed. Methods: This work constitutes a retrospective study of OSA adult patients subjected to the following surgical procedures: different types of pharyngoplasties, tongue-base surgery, partial epiglottectomy or hyoid suspension. Those who exclusively underwent tonsillectomy or nasal surgery were excluded. Before surgery, a sleep study, and an assessment of the patients' sleepiness and quality of life were performed, which were repeated at 8, 34, and 48 months after surgery. A total of 153 patients was included. Results: Following surgery, the apnea–hypopnea index decreased from 34.84/h to 14.54/h and did not vary more than one point in subsequent controls (p = 0.01). The oxygen desaturation index changed from 31.02/h to 14.0/h and remained stable in the second (15.34/h) and third (11.43/h) controls (p = 0.01). Parameters measuring sleepiness and well-being demonstrated the maintenance of long-term benefits. New pharyngoplasties were observed to be more stable than classic pharyngoplasties in the long term (p = 0.04). Single-level surgeries were found to be more stable than multilevel surgeries, although a statistically significant difference was not observed (p = 0.07). Conclusion: The benefits obtained remained stable in the long term. In our sample, modern pharyngoplasty techniques showed superiority over the classic ones regarding long-term stability. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) is a chronic disorder characterized by recurrent episodes of upper airway collapse during sleep, which can lead to serious health issues like cardiovascular disease and neurocognitive impairments. While positive airway pressure serves as the standard treatment, intolerance in some individuals necessitates exploration of alternative therapies. Hypoglossal nerve stimulation (HGNS) promises to mitigate OSA morbidity by stimulating the tongue muscles to maintain airway patency. However, its effectiveness varies, prompting research for optimization. This review summarizes the effects of HGNS on upper airway obstruction from human and animal studies. It examines physiological responses including critical closing pressure, maximal airflow, nasal and upper airway resistance, compliance, stiffness, and geometry. Interactions among these parameters and discrepant findings in animal and human studies are explored. Additionally, the review summarizes the impact of HGNS on established OSA metrics, such as the apnea-hypopnea index, oxygen desaturation index, and sleep arousals. Various therapeutic modalities, including selective unilateral or bilateral HGNS, targeted unilateral HGNS, and whole unilateral or bilateral HGNS, are discussed. This review consolidates our understanding of HGNS mechanisms, fostering exploration of under-investigated outcomes and approaches to drive advancements in HGNS therapy. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea syndrome (OSA) is a multi-factorial disorder, with quite complex endotypes, consisting of anatomical and non-anatomical pathophysiological factors. Continuous positive airway pressure (CPAP) is recognized as the first-line standard treatment for OSA, whereas upper airway (UA) surgery is often recommended for treating OSA patients who have refused or cannot tolerate CPAP. The main results achievable by the surgery are UA expansion, and/or stabilization, and/or removal of the obstructive tissue to different UA levels. The site and pattern of UA collapse identification is of upmost importance in selecting the customized surgical procedure to perform, as well as the identification of the relation between anatomical and non-anatomical factors in each patient. Medical history, sleep studies, clinical examination, UA endoscopy in awake and drug-induced sedation, and imaging help the otorhinolaryngologist in selecting the surgical candidate, identifying OSA patients with mild UA collapsibility or tissue UA obstruction, which allow achievement of the best surgical outcomes. Literature data reported that the latest palatal surgical procedures, such as expansion sphincter palatoplasty or barbed reposition palatoplasty, which achieve soft palatal and lateral pharyngeal wall remodeling and stiffening, improved the Apnea Hypopnea Index, but the outcome analyses are still limited by methodological bias and the limited number of patients’ in each study. Otherwise, the latest literature data have also demonstrated the role of UA surgery in the improvement of non-anatomical factors, confirming that a multidisciplinary and multimodality diagnostic and therapeutical approach to OSA patients could allow the best selection of customized treatment options and outcomes. [ABSTRACT FROM AUTHOR]

THRIVE stands for Transnasal Humidified Rapid Insufflation Ventilatory Exchange. Usage of THRIVE technique is common in emergency settings and of late its usage in upper airway surgeries is gaining popularity. (1) To determine the operative time, total anaesthesia time, safety and efficacy of THRIVE in patients undergoing upper airway surgeries for varied pathologies. (2) To assess the surgeon's satisfaction and patients post-operative comfort. An observational study was from May 2019 to Oct 2020. Study was conducted through a detailed proforma which consists of patient demographic details, physical status, co-morbidities and various domains to assess the safety and efficacy of THRIVE. A total of 32 patients were divided into four groups depending on the type of surgery. We had 18 patients in microlaryngeal excision, six in direct laryngoscopy and biopsy, four in tracheostomy and four in balloon dilatation for subglottic stenosis groups. The mean operation time was 16 ± 2 min in the first three groups and 29 ± 0.8 in the fourth group. All the patients underwent successful surgeries without any episodes of desaturation, without complications and with good surgical satisfaction. THRIVE with appropriate safety precautions can be tried in patients undergoing various upper airway surgeries of short duration. All the patients in our study maintained stable vital parameters throughout the surgery. Initial results with the use of THRIVE as per our study and other studies are definitely encouraging to use THRIVE in upper airway surgeries with varied pathologies. [ABSTRACT FROM AUTHOR]

Background: An innovative approach for the primary and definitive treatment of obstructive sleep apnea (OSA) in adult patients is presented: Bilateral Internal Ramus Distraction of the mandible (BIRD), which is a slow, progressive and more stable procedure to advance the mandibular bone. This study investigated whether this surgical approach is useful to cure OSA.Methods: Study design was of an interventional (surgical) one-arm trial of OSA patients assessed before and 12 months after BIRD. All patients were evaluated by pre- and post-operative polysomnography and three-dimensional scans. The amount of skeletal advancement, percentage of upper airway volume increase and postoperative value of mandibular occlusal plane were the predictor variables. Changes in the apnoea-hypopnoea index (AHI), oxygen desaturation index (ODI), and percentage of time with saturation under 90% (TC90) were the main outcome variables.Findings: Thirty-two subjects with a mean ± SD age of 41.9 ± 13.3 years and 87.5% male were included, and they were followed-up 32 ± 14.2 months. AHI was 47.9 ± 23.1 per hour before surgery and the Epworth Sleepiness Scale (ESS) was 13.4 ± 4.4. Postoperative AHI was 4.8 ± 5.6 per hour 12 months after surgery (P < 0.001), with 81.2% of the patients considered cured (AHI<5) and 18.8% suffering from a mild-to-moderate residual OSA. ESS decreased to 1.9 ± 1.8 at the end of the surgical treatment (P < 0.001). 3D changes revealed an upper airway volume increase of 188.4% ± 73.5% (P < 0.001).Interpretation: Lengthening the mandibular ramus by distraction osteogenesis to cure OSA appears to be more effective and safer when compared to other surgical protocols, especially in very severe cases with initial AHI>50/h. Titration of the mandibular advancement weekly using respiratory polygraphy allows better healing control and customization of the skeletal advancement, enhancing the aesthetic result. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of tonsillectomy and expansion sphincter pharyngoplasty (ESP) in the surgical treatment of obstructive sleep apnea (OSA)., Methods: OSA patients with Friedman grade III-IV tonsil hypertrophy diagnosed with polysomnography were separated into two groups according to the surgery performed, as the classic tonsillectomy group (Group 1) and the ESP group (Group 2). The primary endpoint of the study was to determine the Apnea-Hypopnea Index (AHI) value., Results: Group 1 comprised 24 patients with median preoperative AHI of 19.7 and postoperative AHI of median 11.8 ( p  = .0001). Group 2 comprised 29 patients with median preoperative AHI of 25.1 and postoperative AHI of median 16.3 ( p  = .0001). Nine (37.5%) of the 24 patients in Group 1 accepted as cure (79.1%). Eight (27.5%) of the 29 patients in Group 2 accepted as cure (72.4%)., Conclusion: There was no superiority of ESP over tonsillectomy in patients with lateral pharyngeal obstruction.

Objectives/Hypothesis: Systemic infusions of lidocaine have been widely used as perioperative analgesic adjuvants. The aim of this randomized, double‐blinded, controlled trial was to investigate the effect of perioperative lidocaine infusion on postoperative early recovery quality in upper airway surgery. Study Design: Prospective, randomized, double‐blinded, placebo‐controlled trial. Methods: A total of 99 patients were randomly assigned to the lidocaine group (group L) or the control group (group C). The patients received 2 mg/kg lidocaine completed within 10 minutes before the induction of anesthesia followed by continuous infusions of 2 mg/kg/hr lidocaine (group L) or the same volume of 0.9% normal saline (group C) intravenously during anesthesia. The Quality of Recovery‐40 (QoR‐40) survey was administered on the preoperative day (Pre) and postoperative days 1 (POD1) and 2 (POD2). The primary endpoint was QoR‐40 score on POD1 and POD2. Results: Compared with Pre, global QoR‐40 scores on POD1 and POD2 were significantly lower (P <.05). Compared with group C, global QoR‐40 scores were significantly higher in group L on POD1 and POD2 (P <.05). Among the five dimensions of QoR‐40, the scores for physical comfort, emotional state, and pain were superior in group L compared to group C (P <.05). Compared with group C, the consumption of remifentanil and diclofenac as well as the incidence of postoperative nausea and vomiting (PONV) and postoperative 48‐hour numeric rating scale (NRS) scores in group L were significantly lower (P <.05). Conclusions: Systemic lidocaine infusion can improve QoR‐40 scores in patients with upper airway surgery, reduce the dosage of intraoperative opioids, decrease the incidence of PONV and NRS scores 2 days after surgery, thus improving postoperative early recovery quality. Level of Evidence: 1b Laryngoscope, 131:E63–E69, 2021 [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the influence of position-dependency on surgical success of upper airway (UA) surgery in obstructive sleep apnea (OSA) patients. Methods: Systematic review. Results: Two prospective cohort studies and seven retrospective cohort studies were included in this review. Despite the importance of the subject, it remains unclear whether position-dependency is a predictor for surgical success. No differences were found in surgical success rate between non-positional (NPP) and positional (PP) OSA patients undergoing uvulopalatopharyngoplasty/Z-palatoplasty with or without radiofrequent thermotherapy of the tongue, isolated tongue base or multilevel surgery and hypoglossal nerve stimulation. In one study PP undergoing relocation pharyngoplasty had a greater chance of surgical success. In the majority of the remaining studies, surgical success was in favor of NPP. Furthermore, in the vast part of included studies, the effect of UA surgery was suggested to be greater in the lateral position than supine position. Conclusion: Although preoperative characteristics in PP (e.g., lower BMI and AHI) seem to be in favor for higher surgical success compared to NPP, it remains unclear whether position-dependency is a predictor for surgical outcome. It is suggested that the largest differences and expected preoperative and postoperative changes occur in non-supine AHI. In PP, the preoperative non-supine AHI is already lower compared to NPP suggesting a lower chance of surgical success in PP. [ABSTRACT FROM AUTHOR]

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Introduction Obstructive sleep apnea syndrome (OSAS) is a multifactorial disease characterized by episodes of partial or complete collapse during sleep of different regions of the upper airway. Surgery for OSAS evolved with the introduction of different techniques, considering new surgical concept of reconstruction of the upper airway. Objective To retrospectively evaluate the effectiveness of a new approach aimed at reducing pharyngeal collapse by combining two surgical techniques: lateral and expansion pharyngoplasty. Methods We reviewed the medical records of 38 patients with OSAS undergoing lateral/expansion pharyngoplasty from January 2012 to December 2016. The following data were collected: patient age, gender, and pre- and postoperative body mass index (BMI), Epworth sleepiness scale (ESS) scores, snoring visual analogue scale (VAS) scores, and polysomnography (PSG) results. Results The PSG results showed a significant reduction in the apnea/hypopnea index (AHI) from 22.4 ± 27.3 events/h preoperatively to 13.6 ± 17.9 events/h postoperatively (p = 0.009), with postoperative AHI reduction greater than 50% in 63.2% of the patients. There was also a significant reduction in the microarousal index (19.5 ± 22.6 vs 11.0 ± 13.4 events/h; p = 0.001) and in the minimum oxygen saturation (82.6 ± 10.3 vs 86.9 ± 11.1; p = 0.007). Conclusions Lateral-expansion pharyngoplasty represents a new surgical strategy for the treatment of OSAS in patients with palatal collapse by combining two different techniques: lateral and expansion pharyngoplasty. The two techniques, performed as a one-stage procedure, led to improvements in excessive daytime sleepiness, snoring, and PSG respiratory parameters by acting on lateral and retropalatal collapse, producing favorable results with good applicability in otolaryngology clinical practice.

The article discusses several studies on alternative and complementary treatments for obstructive sleep apnea (OSA). They include a randomized controlled trial of cognitive behavior therapy for insomnia and positive airway pressure (PAP) for OSA that was published in the 2020 issue of "Sleep," and comparing treatment effects of a convenient vibratory positional device to continuous PAP that was published in the 2020 issue of "Thorax."

Obstructive sleep apnea syndrome (OSA) is a multi-factorial disorder, with quite complex endotypes, consisting of anatomical and non-anatomical pathophysiological factors. Continuous positive airway pressure (CPAP) is recognized as the first-line standard treatment for OSA, whereas upper airway (UA) surgery is often recommended for treating OSA patients who have refused or cannot tolerate CPAP. The main results achievable by the surgery are UA expansion, and/or stabilization, and/or removal of the obstructive tissue to different UA levels. The site and pattern of UA collapse identification is of upmost importance in selecting the customized surgical procedure to perform, as well as the identification of the relation between anatomical and non-anatomical factors in each patient. Medical history, sleep studies, clinical examination, UA endoscopy in awake and drug-induced sedation, and imaging help the otorhinolaryngologist in selecting the surgical candidate, identifying OSA patients with mild UA collapsibility or tissue UA obstruction, which allow achievement of the best surgical outcomes. Literature data reported that the latest palatal surgical procedures, such as expansion sphincter palatoplasty or barbed reposition palatoplasty, which achieve soft palatal and lateral pharyngeal wall remodeling and stiffening, improved the Apnea Hypopnea Index, but the outcome analyses are still limited by methodological bias and the limited number of patients’ in each study. Otherwise, the latest literature data have also demonstrated the role of UA surgery in the improvement of non-anatomical factors, confirming that a multidisciplinary and multimodality diagnostic and therapeutical approach to OSA patients could allow the best selection of customized treatment options and outcomes.

Introduction Obstructive sleep apnea syndrome (OSAS) is a multifactorial disease characterized by episodes of partial or complete collapse during sleep of different regions of the upper airway. Surgery forOSAS evolvedwiththe introduction of different techniques, considering new surgical concept of reconstruction of the upper airway. Objective To retrospectively evaluate the effectiveness of a new approach aimed at reducing pharyngeal collapse by combining two surgical techniques: lateral and expansion pharyngoplasty. Methods We reviewed the medical records of 38 patients with OSAS undergoing lateral/expansion pharyngoplasty from January 2012 to December 2016. The following data were collected: patient age, gender, and pre- and postoperative body mass index (BMI), Epworth sleepiness scale (ESS) scores, snoring visual analogue scale (VAS) scores, and polysomnography (PSG) results. Results The PSG results showed a significant reduction in the apnea/hypopnea index (AHI) from22.4±27.3events/hpreoperatively to13.6±17.9 events/hpostoperatively (p=0.009), with postoperative AHI reduction greater than 50% in 63.2% of the patients. There was also a significant reduction in the microarousal index (19.5±22.6 vs 11.0±13.4 events/h; p=0.001) and in the minimum oxygen saturation (82.6±10.3 vs 86.9±11.1; p=0.007). Conclusions Lateral-expansion pharyngoplasty represents a new surgical strategy for the treatment of OSAS in patients with palatal collapse by combining two different techniques: lateral and expansion pharyngoplasty. The two techniques, performed as a one-stage procedure, led to improvements in excessive daytime sleepiness, snoring, and PSG respiratory parameters by acting on lateral and retropalatal collapse, producing favorable results with good applicability in otolaryngology clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: Velopharyngoplasty and palatine tonsillectomy are at the very heart of the surgical treatment of obstructive sleep apnea syndrome (OSAS) care. In cases of major tonsil hypertrophy, we evaluated the relevance of associating soft palate surgery with palatine tonsillectomy, independent of the soft palate length. Methods: We conducted a retrospective single-center study in OSAS patients with grade III or IV tonsils treated with tonsillectomy. Preoperative assessment included an upper airway examination performed while the patient was awake, a polysomnography and a drug-induced sedation endoscopy (DISE). Surgical efficacy was assessed on postoperative polysomnography. Success was considered when the postoperative apnea-hypopnea index (AHI) was less than 20 events/h with a 50% reduction. We compared palatine tonsillectomy efficacy alone (group A) and associated with soft palate surgery (group B). Results: We analyzed 33 patients who had undergone surgery between December 2006 and May 2018. Their preoperative mean BMI and mean AHI were 27.3 ± 7.5 kg/m2 and 38.6 ± 21.4 events/h, respectively. The two groups (A, n = 18 and B, n = 15) were clinically comparable. The success rate was 72.2% in group A and 60% in group B. There was no statistically significant difference between the two groups (p > 0.1). Conclusions: According to this study, in our institution, in cases of major tonsillar hypertrophy, simultaneous soft palate surgery had no significant impact on the success rate, regardless of soft palate length. Associating soft palate surgery with palatine tonsillectomy does not seem mandatory to increase the success rate. Level of evidence: III. Retrospective comparative study [ABSTRACT FROM AUTHOR]

Objective: A surgical response to upper airway (UA) surgery for obstructive sleep apnea (OSA) depends on adequate correction of collapsible sites in the UA. This pilot study aimed to examine the surgical response to UA surgery directed by drug-induced sleep computed tomography (DI-SCT) for OSA.Study Design: Prospective case series.Setting: Tertiary referral center.Subjects and Methods: This study recruited 29 OSA patients (median age, 41 years; median body mass index, 26.9 kg/m2) who underwent single-stage DI-SCT-directed UA surgery between October 2012 and September 2014. DI-SCT was performed with propofol for light sedation with a bispectral monitor before and after UA surgery. Nonresponders were defined as those with a reduction in apnea-hypopnea index <50% after 6 months following UA surgery.Results: DI-SCT showed that 28 (97%) patients had collapses at multiple sites, all of whom underwent multilevel UA surgery accordingly. The apnea-hypopnea index decreased from 53.6 to 26.8 ( P < .001). There were 18 (62%) nonresponders and 11 (38%) responders. Multiple-site collapses could not predict surgical response ( P > .99). The nonresponders had significant improvements in velopharyngeal, oropharyngeal lateral wall, and tongue collapses (all P < .05), whereas the responders had significant improvements in velopharyngeal and oropharyngeal lateral wall collapses (both P ≤ .05).Conclusion: Despite multilevel OSA surgery, residual UA obstruction in nonresponders likely occurs due to multiple mechanisms. DI-SCT may help to elucidate the reasons for a nonresponse. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to evaluate the effects of upper airway surgery on daytime sleepiness in nonobese patients with obstructive sleep apnea/hypopnea syndrome (OSA). Methods: This retrospective study included 121 consecutive adult nonobese patients with OSA from a tertiary academic medical center. Patients with OSA who refused continuous positive airway pressure therapy, or in whom it was unsuccessful, and then underwent OSA surgery were enrolled. Evaluations of excessive daytime sleepiness using the Epworth Sleepiness Scale (ESS) and major parameters of objective full-night polysomnography were collected preoperatively and at least 3 months postoperatively. Statistical analysis was performed using the Wilcoxon signed rank test and Wilcoxon rank sum test. Results: When pre- and postoperative ESS and polysomnographic parameters were compared in all patients, ESS scores, apnea/hypopnea index, and snoring index showed statistically significant improvements (P = .007, P < .001, and P < .001, respectively). When patients were classified into mild, moderate, and severe OSA groups, snoring index had statistically significant improvements in all 3 groups, and apnea/hypopnea index had statistically significant decreases in the moderate and severe OSA groups. Although reductions in ESS scores were found in all 3 groups, the most statistically significant improvement was noted only in the severe OSA group. Conclusions: OSA surgery can improve daytime sleepiness in nonobese patients with OSA, especially for patients with severe OSA. This study elucidates the effects of OSA surgery on daytime sleepiness by excluding the major confounding factor of obesity. This study adds to the literature on the effects of upper airway surgery for nonobese patients with OSA on daytime quality of life. [ABSTRACT FROM AUTHOR]

Purpose: Obstructive sleep apnea (OSA) is a common sleep disorder that can be corrected with upper airway surgery. Prior to surgery, drug-induced sleep endoscopy (DISE) is routinely used to evaluate obstruction sites and severity. Evidence suggests that the findings of DISE may relate to the final surgical outcome. Therefore, we evaluated the ability of drug-induced sleep endoscopy to predict the final effect of upper airway surgery and potentially to guide surgical treatment decision-making.Methods: A retrospective analysis was conducted on 85 adult patients with OSA (50 men with mean apnea-hypopnea index [AHI] 30 ± 15 events/h) who underwent DISE followed by tonsillectomy, uvulopalatopharyngoplasty (UPPP), or a combination of the two. Surgery outcome was evaluated at follow-up by polysomnography. Success response to surgery was defined as a postoperative value of the AHI< 20 events/h and more than 50% postoperative reduction of AHI.Results: Of the 85 patients evaluated, 48 (53%) were responders. DISE revealed significant differences between the two groups. Specifically, complete circumferential collapse at the velum and complete anterior-posterior collapse at the tongue base occurred at higher frequencies in nonresponders. In contrast, the presence of grade 3-4 tonsillar hypertrophy and anterior-posterior mild/partial collapse at the velum were positively associated with responders.Conclusions: Our results suggest that DISE may help predict the final outcome of tonsillectomy, UPPP, or a combination of the two in adult patients with OSA. The use of DISE shows potential to guide treatment decisions for individual patients with OSA. [ABSTRACT FROM AUTHOR]

Abstract Unanticipated difficult airway is a challenging problem for anesthesiologists. Oropharyngeal stenosis (OPS) is a rare complication of upper airway surgery which may cause difficult airway. We present a patient whose postsurgical OPS was revealed during the induction of general anesthesia, and necessitated reschedule of surgery and tracheotomy. We also discuss the etiology and risk factors of postsurgical OPS.

Background and Objective: Obstructive sleep apnea (OSA) is defined as a sleep disordered breathing due to partial or complete obstruction of upper airways. This study aimed to investigate treatment outcomes and clinical complications among patients with OSA who underwent upper airway surgery in clinical settings. Materials and Methods: All patients undergone upper airway surgery for OSA were called upon to enroll in this follow-up study. Demographic characteristics, Epworth sleepiness scale (ESS), snoring, dry mouth, nocturia, improvement of high blood pressure, and complications of surgery including bleeding, infection, pain, and temporary voice change were recorded at median of 8 months after the surgery. 12 patients accepted to undergo follow-up polysomnography (PSG). Results: Among 41 participants, mean age was 44.2 ± 11.6 years, and 33 (78.6%) were male. In three patients (25%) with follow-up PSG, mean respiratory disturbance index (RDI) was decreased by 50%. The baseline and post-surgery RDI was 34.0 ± 26.2 and 24.8 ± 13.2/hours, respectively. Mean ESS pre-surgery was 9.0 ± 4.5 with a decrease of 3.9 ± 4.2 post-surgery. Most of the participants reported improved snoring. More than half of the patients reported improvement of hypertension, dry mouth, nocturia, and sleep quality. The most common reported complications were temporary changes in voice and pain. Conclusion: Surgery improved snoring, daytime sleepiness, and OSA-related problems. RDI improvement in a small subset of patients indicates importance of follow-up PSG after upper airway surgery and warrants further studies. Moreover, evaluation of the reasons of non-participation for undergoing follow-up PSG requires more investigation.