US performed by a skilled operator is a reliable tool for adenoma localization prior to minimally invasive parathyroidectomy. If the US findings are inconclusive, a Tc-sestamibi scan should be used. If there is a high clinical suspicion of adenoma in the presence of negative imaging studies, bilateral neck exploration should be performed.

Obstructive sleep apnea (OSA) is a common disorder, characterized by cyclic cessation of airflow for 10 seconds or more. There is growing awareness that OSA is related to the development and progression of cardiovascular disease. However, only a few studies have associated OSA directly to major cardiovascular events. The aim of this study was to evaluate the relationship between OSA and cardiovascular morbidity in a well defined population of patients.The electronic database of the central district of a major health management organization was searched for all patients diagnosed with OSA in 2002–2010. For each patient identified, an age- and sex-matched patient was randomly selected from the members of the same health management organization who did not have OSA. Data on demographics, socioeconomic status, and relevant medical parameters were collected as well.The study population included 2797 patients, average age 58.1, in which 76.6% were males. There was a significant correlation between OSA and the presence of ischemic heart disease (P < 0.001), pulmonary hypertension (P < 0.001), congestive heart failure (P < 0.001), cardiomyopathy (P = 0.003), and arrhythmia (P < 0.001). OSA was also significantly correlated with low socioeconomic status (P < 0.001).OSA and cardiovascular disease were strongly correlated. As such, early diagnosis and treatment of OSA may change the course of both diseases. We suggest that sleep disordered breathing should be routinely assessed in patients with cardiovascular problems. An ear–nose–throat evaluation may also be important to rule out anatomic disorders that cause upper airway obstruction.

Our results suggest that the same treatment strategy should be applied to all patients with primary hyperparathyroidism. Ultrasound appears to be the localization procedure of choice in younger patients.

About 25% of eucalcemic patients may have elevated PTH levels after parathyroidectomy. A high preoperative PTH level (>225 pg/mL) may predict a persistently high postoperative level. Evaluation of blood and urine calcium, bone density, and cardiac function should be considered in affected patients.

Surgical treatment of PHPT has both physiological benefits and helps to preserve quality of life. Our findings suggest that there is no practical difference in perioperative management and surgical outcomes for older patients. Surgeons should consider parathyroidectomy in PHPT patients regardless of age.

Subtotal resection for TH may be insufficient. The use of iPTH monitoring is recommended. Renal transplant recipients have distinctive characteristics and require special perioperative attention.

Patients after partial glossectomy and radial forearm free flap reconstruction appear to be at high risk of obstructive sleep apnea. Testing for OSA should be considered in these patients.

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