The purpose of this study was (1) to examine the factors that account for the variability in continuous positive airway pressure (CPAP) levels required to abolish obstructive sleep apnea (OSA) in patients with this disorder, and (2) to examine the feasibility of predicting the lowest effective pressure (CPAPmin) from simple anthropometric and polysomnographic variables easily available in all patients considered for home CPAP therapy. To accomplish these tasks we studied a group of 208 patients with OSA all of whom were treated with nasal CPAP at home. We first analyzed a model set of 38 patients all of whom had at least two polysomnographic studies (the diagnostic one and a subsequent one to determine CPAPmin for home use), anthropometric measurements (including body mass index, neck circumference, and waist circumference), pulmonary function measurements (lung volumes, airways resistance, and flow-volume curves), pharyngeal and glottic cross-sectional areas at functional residual capacity and residual volume, and nasal airflow resistances. We compared patients requiring CPAP > 10 cm H2O with those who required CPAP < 5 cm H2O. The high CPAP group was characterized by a greater degree of obesity, more severe sleep apnea, and more collapsible pharynx. Multiple linear regression analysis using principal components and Mallows C(P) statistics revealed that the optimal set of predictors for CPAPmin consisted of only three variables: apnea/hypopnea index, body mass index, and neck circumference. This model accounted for 76% of the variability in CPAP.(ABSTRACT TRUNCATED AT 250 WORDS)

The purpose of this study was to compare apnea and snoring in patients with different patterns of nasal resistance: normal, high unilateral, and high bilateral. The authors examined 683 unselected patients referred for evaluation of snoring and possible sleep apnea. All patients had determination of nasal resistance (performed during wakefulness in the seated posture) and nocturnal polysomnography including quantitative measurement of snoring. Analysis of variance showed no significant difference in apnea and snoring indices among the three nasal resistance groups (normal, high unilateral, and high bilateral). Furthermore, there was no significant difference in the frequency of patients with different severity of apnea and snoring among the three groups. It is concluded that 1. unilateral and bilateral elevation of nasal resistance may lead to equally severe snoring or apnea; 2. there is no direct relationship between awake seated nasal resistance measurement and sleep disordered breathing; and 3. measurements of supine nasal resistance during sleep may be required to elucidate the relationship between sleep-disordered breathing and nasal obstruction.

This study was designed to assess the subjective and objective effects of uvulopalatopharyngoplasty (UPPP) for treatment of snoring. We mailed a questionnaire dealing with snoring, quality of sleep, and interference with bed-partner's sleep to 100 unselected patients who were referred because of snoring. Replies were received from 69 patients. The answers were analyzed, and the subjective impressions were compared with preoperative and postoperative objective measurements of snoring and apnea. The average (+/- SD) length of follow-up was 45 +/- 20 mo. We found no significant differences in the apnea/hypopnea index, snoring index, and mean and maximal nocturnal sound intensity before and after surgery in this group. However, despite this lack of objective improvement. 78% of patients reported reduction in snoring, and 79% reported improvement in the quality of sleep; 18 of 69 bed partners no longer complained of interference with their sleep compared with only one preoperatively. We conclude that if the purpose of UPPP is to reduce the reported health hazards associated with snoring, then comparison between objective preoperative and postoperative measurements of snoring does not indicate success; if, on the other hand, the purpose of surgery is to alleviate the social hazard, then UPPP partially achieves this goal.

Nasal respiratory airflow resistances of awake snorers averaged 0.188 +/- 0.165 Pa/cm3/s (N = 306) and were not elevated beyond the normal range (less than 0.25 Pa/cm3/s). Resistances were decreased substantially from a mean of 0.164 +/- 0.128 to 0.065 +/- 0.037 Pa/cm3/s (N = 72) by a nasal vestibular dilator (Nozovent). Effects of the dilator on breathing disorders in sleep were determined by polysomnographic recordings that included frequency, duration and intensity of snoring, apneas, hypopneas, and oxygen saturation in 10 heavy snorers while asleep with and without the dilator in situ over periods of several hours. No significant changes were detected in these parameters in any stage of sleep.

Although it is widely accepted that nasal obstruction leads to snoring and sleep apnea, the relationship between these variables is not clear, mainly because of the lack of studies in which nasal resistance (Rna) and snoring were measured concurrently. The authors studied eight nonapneic snoring men with healthy noses by nocturnal polysomnography that included quantitative assessment of snoring and concomitant nasal resistance. In six of these eight patients nasal resistance increased during sleep, but there was no significant change for the group as a whole between wakefulness (0.209 +/- 0.224 Pa/cm3 per second) and sleep (0.292 +/- 0.203 Pa/cm3 per second). Linear regression analysis showed no significant correlation between sleeping nasal resistance and snoring index (partial R2 = .44, P = .071). We used each subject as his own control and compared the snoring profile at a time during sleep when nasal resistance was at its highest (0.550 +/- 0.375 Pa/cm3 per second) and lowest (0.146 +/- 0.090 Pa/cm3 per second) levels. Despite the significant (P < .01) differences in nasal resistance, they were not reflected in the number of snores or their sound intensity. It is concluded that nasal obstruction during sleep is not correlated significantly to frequency or intensity of snoring during exclusively nasal breathing.

Background It has become clear that healthcare workers are at high risk, and otolaryngology has been theorized to be among the highest risk specialties for coronavirus disease 2019 (COVID‐19). The purpose of this study was to detail the international impact of COVID‐19 among otolaryngologists, and to identify instructional cases. Methods Country representatives of the Young Otolaryngologists–International Federation of Otolaryngologic Societies (YO‐IFOS) surveyed otolaryngologists through various channels. Nationwide surveys were distributed in 19 countries. The gray literature and social media channels were searched to identify reported deaths of otolaryngologists from COVID‐19. Results A total of 361 otolaryngologists were identified to have had COVID‐19, and data for 325 surgeons was available for analysis. The age range was 25 to 84 years, with one‐half under the age of 44 years. There were 24 deaths in the study period, with 83% over age 55 years. Source of infection was likely clinical activity in 175 (54%) cases. Prolonged exposure to a colleague was the source for 37 (11%) surgeons. Six instructional cases were identified where infections occurred during the performance of aerosol‐generating operations (tracheostomy, mastoidectomy, epistaxis control, dacryocystorhinostomy, and translabyrinthine resection). In 3 of these cases, multiple operating room attendees were infected, and in 2, the surgeon succumbed to complications of COVID‐19. Conclusion The etiology of reported cases within the otolaryngology community appear to stem equally from clinical activity and community spread. Multiple procedures performed by otolaryngologists are aerosol‐generating procedures (AGPs) and great care should be taken to protect the surgical team before, during, and after these operations.

No abstract

Obese patients have a high prevalence of obstructive sleep apnoea (OSA), but a low response rate and high frequency of relapse after uvulopalatopharyngoplasty (UVPP). In this study we have determined the level of obstruction during sleep in 31 men with OSA, using a catheter with multiple micropressure transducers and a portable digital recorder. The proportion of apnoeic episodes with obstruction at lower levels correlated with increasing body mass index (BMI) (P < 0.05). Thus, with increasing obesity, there seems to be a shift to a lower level of obstruction. All patients with BMI > 30 and apnoea index (AI) > 5 had predominantly lower obstructions (P < 0.05). This may explain why many obese patients fail to respond, or have relapses after UVPP.