<strong>Backgroun</strong><strong>d</strong><strong>:</strong> Obstructive sleep apnea (OSA) has cardiovascular, neurological, and social complications. Surgical treatment has the p...<strong>Backgroun</strong><strong>d</strong><strong>:</strong> Obstructive sleep apnea (OSA) has cardiovascular, neurological, and social complications. Surgical treatment has the potential to improve airway patency but when and which surgery should be done is a controversy. <strong>Aims and objective<strong>s</strong></strong><strong>:</strong> To estimate the site of obstruction in patients with OSAS and to assess the surgical results of the site (of obstruction) directed surgical treatment.<strong> Methodology: </strong>Twenty patients with OSAS were included in the study with Eight adults and Twelve children. It was a prospective study. All patients were assessed for the airway collapse and surgery was done accordingly. Repeat PSG was done after surgery for success rate after 4 months of follow up. <strong>Result:</strong> 17 patients successfully completed the follow-up. Four (50%) adults and Two (17%) children have grade I or II tonsils while Four (50%) of adults and Ten (83%) children have tonsil size grade III or IV. Seven (88%) adults and one (8%) of the children have adenoid hypertrophy up to grade II. One adult (12%) and nine children (75%) have grade III Adenoid size. Two children (17%) have Adenoid grade IV size. In Four patients retropalatal more than retroglossal collapse was found (50%). One patient (12%) had retroglossal more than retropalatal collapse other one had only retropalatal collapse, and the other one had retroglossal collapse. ESS (Epworth sleepiness scale) decreased postoperatively in both groups. There is a significant change in AHI with the median pre-op AHI being 40.19 to median post-op AHI being 11.35 with a p-value 0.017. Apnea-hypopnea index (AHI) in children pre-operatively was 12.98 (median) changed to 2.15 (median) which is statistically significant. Only one adult patient (12%) is surgically cured while in five patients (63%) surgical success achieved with a surgical success rate of 5/8 (63%). Whereas only one patient is surgically cured 1/8 (13%). Eight patients achieved surgical success with a total success rate of 8/9 (89%). While only two patients achieved surgical cure (23%) among children. Conclusion: The outcome of site-directed surgical treatment is that it is a satisfactory way of treatment of OSAS with an overall success rate of 76%.展开更多
Obstructive sleep apnoea, OSA, is formally defined as an apnoeahypopnoea index (AHI) of at least 5 episodes/hour (mild). Obesity, alcohol, smoking and sedatives may contribute to the development of OSA, as well as ton...Obstructive sleep apnoea, OSA, is formally defined as an apnoeahypopnoea index (AHI) of at least 5 episodes/hour (mild). Obesity, alcohol, smoking and sedatives may contribute to the development of OSA, as well as tonsilar hypertrophy and maxillary and/or mandibular retrognathia. Endocrine conditions such as hypothyroidism and acromegaly have also been reported associated with OSA. Except for excessive daytime sleepiness, headaches and irritability, OSA may lead to hypertension, heart failure, MI and stroke. Management involves reduction of predisposing factors such as obesity and alcohol. Treatment with continuous positive airway pressure (CPAP) is currently most common and best documented. Also uvulopalatopharyngeal surgery and so called phase II surgery, which means advancement of the jaw(s) with orthognatic surgical methods are used. Treatment with dental appliances is getting increasingly popular but the long term outcome remains debatable.展开更多
Introduction: Obstructive sleep apnoea (OSA) is a condition characterized by episodic partial or complete obstruction of the upper airway during sleep leading to apnoea or cessation of breathing. Obstruction of the up...Introduction: Obstructive sleep apnoea (OSA) is a condition characterized by episodic partial or complete obstruction of the upper airway during sleep leading to apnoea or cessation of breathing. Obstruction of the upper airway during sleep may result in the generation of noise (snoring), reduction (hypopnoea) or cessation (apnoea) of airflow at the nostrils and mouth. There are multiple indications for undertaking a patient for adenoidectomy and/or tonsillectomy with obstructive sleep apnoea (OSA) being one among many. Objective: The aim of the present study was to find the prevalence of OSA symptoms in children undergoing adenotonsillectomy for indications other than that of obstructive sleep apnoea. Material & Methods: The study was conducted in the Department of ENT and Head & Neck surgery, Gauhati Medical College & Hospital, Guwahati for a period of one year. Twenty six patients who underwent adenoidectomy and/or tonsillectomy during this period were selected for the study. The parents of the patients were administered the Paediatric Sleep Questionnaire pre-operatively and the patients were evaluated for any symptoms of OSA. A score of 8 or more was suggestive of presence of breathing related sleep disorder. All statistical analyses were performed using statistical software SPSS 16.0 version. To test for the difference in the proportion between different variables, chisquare/fisher exact test where appropriate were employed. All statistical tests were two tailed with 0.05 as the threshold level of significance. Results: 11 children (42.3%) had a score of 8 or more out of the 26 children in Paediatric sleep questionnaire. The chi square for this was 4.696 with a p value of 0.096. The snoring subscale was found to be positive in 19 children (73.1%). All children with score of 8 or more were positive for the snoring scale. The sleepiness subscale was found to be positive in 14 children (53.8%). 10 of the 11 children were positive for sleepiness scale among the children who had a score of 8 or more in the questionnaire. These were found to be statistically significant. Conclusion: A significant population of the children undergoing routine adenotonsillectomy also has symptoms of obstructive sleep apnoea. The pathophysiology of obstructive sleep apnoea should be borne in mind in all children having adenotonsillar hypertrophy and a prompt and early intervention into these children should be aimed for both the infective etiology and the possible outcomes of their compromise to the airway column for a better quality of life.展开更多
Aim: This article investigates the increasing awareness of Obstructive Sleep Apnoea (OSA) as a potentially serious health risk and highlights the role of the dentist in managing mild to moderate OSA cases which can be...Aim: This article investigates the increasing awareness of Obstructive Sleep Apnoea (OSA) as a potentially serious health risk and highlights the role of the dentist in managing mild to moderate OSA cases which can be improved with an intra-oral mandibular advancement appliance. Methods: Data from referrals to a Prosthodontic Unit from 01-01-2019 to 18-8-2022 were analysed. Results: A total of 240 consecutive referrals to an NHS hospital where a patient was fitted with a mandibular advancement appliance (MAA) were analysed and 160 (67%) were male and 80 (33%) were female. The mean age in years was 52 (2019), 50 (2020), 52 (2021) and 51 (2022). Mean age of male referrals was 51 and female referrals was 53. Conclusion: There are a large number of patients with OSA seeking a dental device and practitioners should be aware of this treatment modality to help the medical team manage OSA. Clinical relevance: Dentists may need to have a greater understanding of OSA and be able to provide MAAs.展开更多
Background: Previous studies of continuous positive airway pressure (CPAP) treatment for obstructive sleep apnoea (OSA) have shown conflicting results on the effect on blood pressure (BP), and patients with chronic ki...Background: Previous studies of continuous positive airway pressure (CPAP) treatment for obstructive sleep apnoea (OSA) have shown conflicting results on the effect on blood pressure (BP), and patients with chronic kidney disease (CKD) have not been included in these studies. As OSA is a frequent comorbidity in patients with CKD, it is of relevance to evaluate the effect of CPAP treatment on BP in this population. Aim: In this prospective follow-up study, we measured the effect of short term CPAP treatment of moderate-to-severe OSA on brachial and central BP, plasma level of syndecan-1 and vasoactive hormones, renal handling of sodium, subjective sleepiness, and quality of life in patients with impaired renal function. Methods: From December 2015 until March 2017, 25 patients were invited to participate in the study at the University Clinic in Nephrology and Hypertension, Aarhus University and Holstebro Hospital. At baseline and at follow-up after three to four months of CPAP treatment, we performed 24 h brachial and central ambulatory BP measurement, blood sampling measurements of plasma concentrations of syndecan-1, renin, angiotensin II, aldosterone, vasopressin, creatinine, haemoglobin A1c, and cholesterol, cardio respiratory monitoring, 24 h urine collection for measurement of urinary excretion of albumin, aquaporin-2, and epithelial sodium channel, Epworth Sleepiness Scale (ESS), and SF-36 (quality of life). Results: At follow-up, the 17 included patients with mean baseline estimated glomerular filtration rate 66 mL/min/1.73 m2 had a significant decrease in systolic office-, 24 h- and daytime-BP (13, 7, and 8 mmHg, respectively, p Conclusion: Short-term CPAP treatment of patients with moderate-to-severe OSA and reduced renal function decreased 24 h- and daytime-BP significantly and reduced urinary albumin excretion. Our results underline the importance of treatment of OSA in hypertensive patients with impaired renal function.展开更多
Purpose This study aimed to determine whether a series of repeated maximal voluntary apnoeas is effective in improving subsequent time trial performance in competitive level track and field athletes.Methods Seventeen ...Purpose This study aimed to determine whether a series of repeated maximal voluntary apnoeas is effective in improving subsequent time trial performance in competitive level track and field athletes.Methods Seventeen competitive runners volunteered for this study and based on their preferred competitive distance they were placed either in the 200 m(5 male,4 female)or 1000 m group(3 male,5 female).On two separate occasions(≤7 days apart),the participants performed a running time-trial that was preceded either by:(i)a standardised warm up(WO)or(ii)a standardised warm up succeeded by five repeated maximal dry static apnoeas(WA).Splenic volume,haematology and cardiovascular parameters were monitor at rest,before and after each time-trial.Results WA resulted in a significantly faster performance(27.51±3.49 s;P=0.009)compared with WO(27.96±3.34 s)in the 200 m group,whereas no differences were observed in the 1000 m group(WA,211.10±26.18 s;WO,215.82±25.13 s,P=0.120).No differences were noted in splenic volume between WO and WA in either group(P≥0.081).Haemoglobin was significantly elevated after breath-holding in the 200 m(+7 g/dL,P=0.041)but not 1000 m group.Conclusion This study demonstrates that five repeated maximal apnoeas are capable of significantly improving a 200 m but not a 1000 m time-trial performance in competitive track and field athletes.展开更多
目的:探讨全麻诱导插管期间,体重指数对患者呼吸暂停安全时限的影响。方法:选择年龄21～63岁,ASAⅠ-Ⅱ级择期手术的全麻病人80例。根据其体重指数(Body mass index,BMI)分为Ⅰ组(正常体重组)20例、Ⅱ组(超重组)20例、Ⅲ组(1°肥胖组...目的:探讨全麻诱导插管期间,体重指数对患者呼吸暂停安全时限的影响。方法:选择年龄21～63岁,ASAⅠ-Ⅱ级择期手术的全麻病人80例。根据其体重指数(Body mass index,BMI)分为Ⅰ组(正常体重组)20例、Ⅱ组(超重组)20例、Ⅲ组(1°肥胖组)20例和Ⅳ组(2°肥胖组)20例。常规静脉麻醉诱导,诱导期间以10L/min的氧流量充分吸氧去氮4min,诱导结束行气管插管,插管完毕后继续脱氧观察,待脉搏氧饱和度(SpO2)降至90%时,接入麻醉机呼吸回路行控制呼吸。记录麻醉诱导末到SpO2下降至90%时的呼吸暂停时限,采集入室初、吸氧去氮后和SpO2降至90%时3个时间点的动脉血作血气分析。结果:各组患者呼吸暂停安全时限明显不同,其时限分别为(542.47±48.24)s(Ⅰ组)、(465.77±32.20)s(Ⅱ组)、(355.13±44.36)s(Ⅲ组)、(227.53±34.23)s(Ⅳ组),组间比较具有显著性差异(P<0.05)。结论:体重指数不同,患者耐受呼吸暂停时限明显不同,随着体重指数的增加,患者耐受呼吸暂停的时限逐渐缩短。展开更多
文摘<strong>Backgroun</strong><strong>d</strong><strong>:</strong> Obstructive sleep apnea (OSA) has cardiovascular, neurological, and social complications. Surgical treatment has the potential to improve airway patency but when and which surgery should be done is a controversy. <strong>Aims and objective<strong>s</strong></strong><strong>:</strong> To estimate the site of obstruction in patients with OSAS and to assess the surgical results of the site (of obstruction) directed surgical treatment.<strong> Methodology: </strong>Twenty patients with OSAS were included in the study with Eight adults and Twelve children. It was a prospective study. All patients were assessed for the airway collapse and surgery was done accordingly. Repeat PSG was done after surgery for success rate after 4 months of follow up. <strong>Result:</strong> 17 patients successfully completed the follow-up. Four (50%) adults and Two (17%) children have grade I or II tonsils while Four (50%) of adults and Ten (83%) children have tonsil size grade III or IV. Seven (88%) adults and one (8%) of the children have adenoid hypertrophy up to grade II. One adult (12%) and nine children (75%) have grade III Adenoid size. Two children (17%) have Adenoid grade IV size. In Four patients retropalatal more than retroglossal collapse was found (50%). One patient (12%) had retroglossal more than retropalatal collapse other one had only retropalatal collapse, and the other one had retroglossal collapse. ESS (Epworth sleepiness scale) decreased postoperatively in both groups. There is a significant change in AHI with the median pre-op AHI being 40.19 to median post-op AHI being 11.35 with a p-value 0.017. Apnea-hypopnea index (AHI) in children pre-operatively was 12.98 (median) changed to 2.15 (median) which is statistically significant. Only one adult patient (12%) is surgically cured while in five patients (63%) surgical success achieved with a surgical success rate of 5/8 (63%). Whereas only one patient is surgically cured 1/8 (13%). Eight patients achieved surgical success with a total success rate of 8/9 (89%). While only two patients achieved surgical cure (23%) among children. Conclusion: The outcome of site-directed surgical treatment is that it is a satisfactory way of treatment of OSAS with an overall success rate of 76%.
文摘Obstructive sleep apnoea, OSA, is formally defined as an apnoeahypopnoea index (AHI) of at least 5 episodes/hour (mild). Obesity, alcohol, smoking and sedatives may contribute to the development of OSA, as well as tonsilar hypertrophy and maxillary and/or mandibular retrognathia. Endocrine conditions such as hypothyroidism and acromegaly have also been reported associated with OSA. Except for excessive daytime sleepiness, headaches and irritability, OSA may lead to hypertension, heart failure, MI and stroke. Management involves reduction of predisposing factors such as obesity and alcohol. Treatment with continuous positive airway pressure (CPAP) is currently most common and best documented. Also uvulopalatopharyngeal surgery and so called phase II surgery, which means advancement of the jaw(s) with orthognatic surgical methods are used. Treatment with dental appliances is getting increasingly popular but the long term outcome remains debatable.
文摘Introduction: Obstructive sleep apnoea (OSA) is a condition characterized by episodic partial or complete obstruction of the upper airway during sleep leading to apnoea or cessation of breathing. Obstruction of the upper airway during sleep may result in the generation of noise (snoring), reduction (hypopnoea) or cessation (apnoea) of airflow at the nostrils and mouth. There are multiple indications for undertaking a patient for adenoidectomy and/or tonsillectomy with obstructive sleep apnoea (OSA) being one among many. Objective: The aim of the present study was to find the prevalence of OSA symptoms in children undergoing adenotonsillectomy for indications other than that of obstructive sleep apnoea. Material & Methods: The study was conducted in the Department of ENT and Head & Neck surgery, Gauhati Medical College & Hospital, Guwahati for a period of one year. Twenty six patients who underwent adenoidectomy and/or tonsillectomy during this period were selected for the study. The parents of the patients were administered the Paediatric Sleep Questionnaire pre-operatively and the patients were evaluated for any symptoms of OSA. A score of 8 or more was suggestive of presence of breathing related sleep disorder. All statistical analyses were performed using statistical software SPSS 16.0 version. To test for the difference in the proportion between different variables, chisquare/fisher exact test where appropriate were employed. All statistical tests were two tailed with 0.05 as the threshold level of significance. Results: 11 children (42.3%) had a score of 8 or more out of the 26 children in Paediatric sleep questionnaire. The chi square for this was 4.696 with a p value of 0.096. The snoring subscale was found to be positive in 19 children (73.1%). All children with score of 8 or more were positive for the snoring scale. The sleepiness subscale was found to be positive in 14 children (53.8%). 10 of the 11 children were positive for sleepiness scale among the children who had a score of 8 or more in the questionnaire. These were found to be statistically significant. Conclusion: A significant population of the children undergoing routine adenotonsillectomy also has symptoms of obstructive sleep apnoea. The pathophysiology of obstructive sleep apnoea should be borne in mind in all children having adenotonsillar hypertrophy and a prompt and early intervention into these children should be aimed for both the infective etiology and the possible outcomes of their compromise to the airway column for a better quality of life.
文摘Aim: This article investigates the increasing awareness of Obstructive Sleep Apnoea (OSA) as a potentially serious health risk and highlights the role of the dentist in managing mild to moderate OSA cases which can be improved with an intra-oral mandibular advancement appliance. Methods: Data from referrals to a Prosthodontic Unit from 01-01-2019 to 18-8-2022 were analysed. Results: A total of 240 consecutive referrals to an NHS hospital where a patient was fitted with a mandibular advancement appliance (MAA) were analysed and 160 (67%) were male and 80 (33%) were female. The mean age in years was 52 (2019), 50 (2020), 52 (2021) and 51 (2022). Mean age of male referrals was 51 and female referrals was 53. Conclusion: There are a large number of patients with OSA seeking a dental device and practitioners should be aware of this treatment modality to help the medical team manage OSA. Clinical relevance: Dentists may need to have a greater understanding of OSA and be able to provide MAAs.
文摘Background: Previous studies of continuous positive airway pressure (CPAP) treatment for obstructive sleep apnoea (OSA) have shown conflicting results on the effect on blood pressure (BP), and patients with chronic kidney disease (CKD) have not been included in these studies. As OSA is a frequent comorbidity in patients with CKD, it is of relevance to evaluate the effect of CPAP treatment on BP in this population. Aim: In this prospective follow-up study, we measured the effect of short term CPAP treatment of moderate-to-severe OSA on brachial and central BP, plasma level of syndecan-1 and vasoactive hormones, renal handling of sodium, subjective sleepiness, and quality of life in patients with impaired renal function. Methods: From December 2015 until March 2017, 25 patients were invited to participate in the study at the University Clinic in Nephrology and Hypertension, Aarhus University and Holstebro Hospital. At baseline and at follow-up after three to four months of CPAP treatment, we performed 24 h brachial and central ambulatory BP measurement, blood sampling measurements of plasma concentrations of syndecan-1, renin, angiotensin II, aldosterone, vasopressin, creatinine, haemoglobin A1c, and cholesterol, cardio respiratory monitoring, 24 h urine collection for measurement of urinary excretion of albumin, aquaporin-2, and epithelial sodium channel, Epworth Sleepiness Scale (ESS), and SF-36 (quality of life). Results: At follow-up, the 17 included patients with mean baseline estimated glomerular filtration rate 66 mL/min/1.73 m2 had a significant decrease in systolic office-, 24 h- and daytime-BP (13, 7, and 8 mmHg, respectively, p Conclusion: Short-term CPAP treatment of patients with moderate-to-severe OSA and reduced renal function decreased 24 h- and daytime-BP significantly and reduced urinary albumin excretion. Our results underline the importance of treatment of OSA in hypertensive patients with impaired renal function.
文摘Purpose This study aimed to determine whether a series of repeated maximal voluntary apnoeas is effective in improving subsequent time trial performance in competitive level track and field athletes.Methods Seventeen competitive runners volunteered for this study and based on their preferred competitive distance they were placed either in the 200 m(5 male,4 female)or 1000 m group(3 male,5 female).On two separate occasions(≤7 days apart),the participants performed a running time-trial that was preceded either by:(i)a standardised warm up(WO)or(ii)a standardised warm up succeeded by five repeated maximal dry static apnoeas(WA).Splenic volume,haematology and cardiovascular parameters were monitor at rest,before and after each time-trial.Results WA resulted in a significantly faster performance(27.51±3.49 s;P=0.009)compared with WO(27.96±3.34 s)in the 200 m group,whereas no differences were observed in the 1000 m group(WA,211.10±26.18 s;WO,215.82±25.13 s,P=0.120).No differences were noted in splenic volume between WO and WA in either group(P≥0.081).Haemoglobin was significantly elevated after breath-holding in the 200 m(+7 g/dL,P=0.041)but not 1000 m group.Conclusion This study demonstrates that five repeated maximal apnoeas are capable of significantly improving a 200 m but not a 1000 m time-trial performance in competitive track and field athletes.
文摘目的:探讨全麻诱导插管期间,体重指数对患者呼吸暂停安全时限的影响。方法:选择年龄21～63岁,ASAⅠ-Ⅱ级择期手术的全麻病人80例。根据其体重指数(Body mass index,BMI)分为Ⅰ组(正常体重组)20例、Ⅱ组(超重组)20例、Ⅲ组(1°肥胖组)20例和Ⅳ组(2°肥胖组)20例。常规静脉麻醉诱导,诱导期间以10L/min的氧流量充分吸氧去氮4min,诱导结束行气管插管,插管完毕后继续脱氧观察,待脉搏氧饱和度(SpO2)降至90%时,接入麻醉机呼吸回路行控制呼吸。记录麻醉诱导末到SpO2下降至90%时的呼吸暂停时限,采集入室初、吸氧去氮后和SpO2降至90%时3个时间点的动脉血作血气分析。结果:各组患者呼吸暂停安全时限明显不同,其时限分别为(542.47±48.24)s(Ⅰ组)、(465.77±32.20)s(Ⅱ组)、(355.13±44.36)s(Ⅲ组)、(227.53±34.23)s(Ⅳ组),组间比较具有显著性差异(P<0.05)。结论:体重指数不同,患者耐受呼吸暂停时限明显不同,随着体重指数的增加,患者耐受呼吸暂停的时限逐渐缩短。
