Background: Obstructive Sleep Apnea (OSA) syndrome is a respiratory sleep disorder characterized by partial or complete episodes of upper airway collapse with reduction or complete cessation of airflow. Although the connection remains debated, several mechanisms such as intermittent hypoxemia, sleep deprivation, hypercapnia disruption of the hypothalamic–pituitary–adrenal axis have been associated with poor neurocognitive performance. Different treatments have been proposed to treat OSAS patients as continuous positive airway pressure (CPAP), mandibular advancement devices (MAD), surgery; however, the effect on neurocognitive functions is still debated. This article presents the effect of OSAS treatments on neurocognitive performance by reviewing the literature. Methods: We performed a comprehensive review of the English language over the past 20 years using the following keywords: neurocognitive performance and sleep apnea, neurocognitive improvement and CPAP, OSAS, and cognitive dysfunction. We included in the analysis papers that correlated OSA treatment with neurocognitive performance improvement. All validated tests used to measure different neurocognitive performance improvements were considered. Results: Seventy papers reported neurocognitive Performance improvement in OSA patients after CPAP therapy. Eighty percent of studies found improved executive functions such as verbal fluency or working memory, with partial neural recovery at long-term follow-up. One article compared the effect of MAD, CPAP treatment on cognitive disorders, reporting better improvement of CPAP and MAD than placebo in cognitive function. Conclusions: CPAP treatment seems to improve cognitive defects associated with OSA. Limited studies have evaluated the effects of the other therapies on cognitive function.
The impact of elective neck treatment (ENT), whether by irradiation or dissection, on the prognosis of patients with cN0 sinonasal carcinomas (SNCs) remains an understudied issue. METHODS: A systematic review and meta-analysis of the literature were performed according to PRISMA guidelines in order to assess regional nodal relapse rate after ENT compared to observation in cN0 SNCs patients. Twenty-six articles for a total of 1178 clinically N0 patients were analyzed. Globally, the 5-year overall survival was 52%; 34.6% of patients underwent ENT and 140 regional recurrences were registered (5.9% in the ENT cohort and 15% in the observation group). ENT appears to confer a lower risk of regional recurrence compared to observation alone, with a cumulative OR of 0.38 (95% CI 0.25–0.58). Our meta-analysis supports the efficacy of ENT for reducing the risk of regional recurrence, but its overall impact on survival remains uncertain.
Background and Objectives
Postoperative morbidity after open partial laryngeal surgery (OPLS) may be serious, leading to a prolonged length of hospital stay and increasing costs. We sought to define the predictive factors of complications and to develop nomograms for patients eligible for OPLS based on clinical and surgical data.
Methods
We critically reviewed 535 patients with laryngeal carcinoma who underwent OPLS at our Institution from 1982 to 2007. We have identified patients affected by postoperative local, airway, dysphagia, bleeding, surgical site infection, dehiscence of pexy, emphysema, and laryngocutaneous fistula complications. We have analyzed them according to age, smoking, alcohol, tumor site, clinical T and N classification, type of OPLS and neck dissection, previous treatments. Prognostic factors were considered in a multivariate logistic regression model with backward stepwise elimination and selected to construct and design nomograms for overall and specific complications. The performance was assessed using the c‐index, receiver operating characteristic, and calibration curves.
Results
Age, clinical T classification, type of OPLS, and alcohol were related to overall (35%) and airway complications. Nomograms were built for overall, dysphagia, and airway complications.
Conclusions
We have developed nomograms that can identify high‐risk patients undergoing OPLS and that can help to prevent severe complications and to tailor surgical planning.
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