DOI: 10.5005/jp-journals-10001-1381 |
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Baptista P, Prieto C, Garaycochea O. Upper Airway Stimulation in the Management of Obstructive Sleep Apnea Syndrome: Neurostimulation of Hypoglossal Nerve. Int J Head Neck Surg 2019; 10 (4):77-85.
Obstructive sleep apnea (OSA) syndrome is one of the most prevalent chronic diseases in the general population. Continuous positive airway pressure (CPAP), is considered the gold standard therapy for its treatment, but adherence is a critical issue that decreases its use. Upper airway stimulation (UAS) through selective hypoglossal nerve stimulation has emerged as a non-anatomically modifying surgery has shown long-term improvements in objective respiratory and subjective quality-of-life outcome measures. It provides multilevel upper airway improvement through its action at the retrolingual and retropalatal portion of the airway, with the advantage of being an adjustable medical device. The two different commercially available implants are Imthera (LivaNova) and Inspire (Inspire Medical Systems). A large amount of information has been described mainly with the Inspire upper airway stimulation system. Patient selection criteria, implantation timeline, the operative procedure with activation and follow-up are discussed. Multiple studies that have shown significant improvements in both subjective and objective outcome measures as apnea hypopnea index (AHI), oxygen desaturation index (ODI), Epworth sleepiness scale (ESS), functional outcomes of sleep questionnaire (FOSQ) have been shown to be maintained respectively at long term follow-up.
The act of sleeping comprises about one-third of our life. It is not just about time, but also the fact that sleeping affects nearly everything that we need to do. Quality of sleep affects quality of life. Obstructive sleep apnea (OSA) is a most common sleep-related breathing disorder, and snoring is the most important symptom. A 30–50% of snorers suffer from OSA, which can further lead to its comorbidities such as arterial hypertension, myocardial infarction, cerebral stroke, depression and anxiety disorders, or impotency disorders. Total body weight, body mass index (BMI), and fat distribution all correlate with odds of having OSA. Obesity causes deposition of adipose in and around the throat, which might lead to snoring and manifest into OSA if left untreated. Every 10 kg increase in weight increases risk by two times. An increase in BMI by six increases risk by four times. In obese patients, even minimal weight loss can be beneficial since it is related to preferential loss of visceral fat first as opposed to subcutaneous fat which has metabolic advantages. Therefore, one of the major modifiable risk factors for developing OSA is obesity. Lifestyle changes in the form of dietary modifications, imparting right knowledge about required nutrition for body, and implementation of the same monitored in a way that can manifest into a permanent behavioral change can go a long way in preventing and curing sleep-related breathing disorders and improving the quality of life of the patient as well as the bed partner.
DOI: 10.5005/jp-journals-10001-1383 |
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Lugo-Saldaña R, Saldívar-Ponce K, González-Sáez I, Hernández-Sirit D, Mireles-García P. Selecting Different Approaches for Palate and Pharynx Surgery: Palatopharyngeal Arch Staging System. Int J Head Neck Surg 2019; 10 (4):92-97.
The examination of the anatomical structures involved in the upper airway collapse in patients with the obstructive sleep apnea-hypopnea syndrome (OSAHS) is a key for integrated evaluation of patients. Our proposal is for a noninvasive classification system that guides us about the presence of anatomical differences between the palatopharyngeal muscle (PFM). The functions of the PFM are narrowing the isthmus, descending the palate, and raising the larynx during swallowing; these characteristics give the PFM a special role in the collapse of the lateral pharyngeal wall. Complete knowledge of the anatomy and classification of different variants can guide us to choose the appropriate surgical procedures for the lateral wall collapse. Until now there is not a consensus about description of the trajectory or anatomical variants of the PFM into oropharynx, the distance between both muscles, and the muscle tone. Here we also present the relationship between the lateral wall surgeries currently available (lateral pharyngoplasty by Cahali, expansion sphincteroplasty by Pang, relocation pharyngoplasty by Li, Roman blinds pharyngoplasty by Mantovani, and barbed sutures pharyngoplasty by Vicini) with the proposed classification of the palatopharyngeal arch staging system (PASS).
Special Issue 4: Invited Article
Aim: Our goal was to present obstructive sleep apnea (OSA) from evolutionary and developmental perspective by highlighting the different elements that predispose humans to develop this condition.
Background: The development of complex speech and bipedalism were some of the adaptations that resulted in changes that predispose humans as a species to the development of OSA. Laryngeal descent and regression of the maxillomandibular complex were some of the changes that took place and that led to a smaller and more collapsible airway. During development, reduction of the posterior airway space and suboptimal growth of the maxillomandibular complex further increase the risk of developing OSA as adults.
Review results: Treatment of OSA should be a continuous effort that starts early in childhood through the establishment of adequate nasal breathing. Chronic mouth breathing during active craniofacial development of a child may result in anatomical changes that directly affect the airway. Different strategies may be applied to optimize nasal breathing and that allow continuous interaction between the nasomaxillary complex and the mandible during development. Ultimately, this will guide the growth of the entire facial-skeletal complex in a forward and horizontal orientation. This will result in a lower risk of developing a narrow and collapsible airway later in life.
Conclusion: Treatment of OSA should be a continuous effort to establish adequate nasal breathing early in life that will maximize the growth and development of the facial-skeletal complex and the upper airway. In order to accomplish this, multiple strategies need to be considered and possibly combined.
Clinical significance: OSA is a common disorder characterized by repetitive upper airway narrowing during sleep with resulting hypoxemia, hypercapnia, sympathetic activation, and sleep disruption. Early intervention in children suspected to have OSA is essential to reduce the risk of developing more severe OSA as adults.
Quality of care should be improved by following the clinical guidelines across the world. Guidelines have potential benefits not only for patients but also for clinicians and healthcare system in formulating the health schemes. Clinicians with sound knowledge need to identify the specific barriers, beyond knowledge, that stand in the way of behavioral change. Recent American Academy of Sleep Medicine (AASM) guidelines 2018 have come up with new recommendations such as split night polysomnography (PSG), repeat PSG in strongly suspected individuals with initial negative PSG and more to improve the specificity of diagnosis.