IMPORTANCETo date, no consensus exists regarding optimal perioperative care of patients with obstructive sleep apnea (OSA) undergoing upper airway (UA) surgery. These patients are at risk related to anesthesia and postoperative analgesia, among other risks associated with difficult airway control, and may require intensified perioperative management.OBJECTIVE To provide a consensus-based guideline by reviewing available literature and collecting expert opinion during an international consensus meeting with experts from relevant speciliaties. EVIDENCE REVIEWIn a consensus meeting conducted on April 4, 2018, a total of 47 questions covering preoperative, intraoperative, and postoperative care were formulated by 12 international experts with extensive clinical experience in the field of UA surgery for OSA. Systematic literature searches were performed by an independent information specialist and 6 researchers according to the Oxford and GRADE systems, and 164 articles published on or before December 31, 2011, were included in the analysis. Two moderators chaired the meeting according to the Amsterdam Delphi Method, including iteration of literature conclusions, expert discussion, and voting rounds. Consensus was reached when there was 70% or more agreement among experts.FINDINGS Of 47 questions, 35 led to a recommendation or statement. The remaining 12 questions provided no additional information and were excluded in the judgment of experts. Consensus was reached for 32 recommendations. For 1 question there was less than 70% agreement among experts; therefore, consensus was not achieved. Highlights of these recommendations include (1) postoperative bleeding is a complication described for all types of UA surgery; (2) OSA is a relative risk factor for difficult mask ventilation and intubation, and plans for difficult airway management should be considered and implemented; (3) safe perioperative care should be provided, with aspects such as OSA severity, adherent use of positive airway pressure, type of surgery, and comorbidities taken into account; (4) although there is no direct evidence to date, in patients undergoing UA surgery, preoperative treatment with positive airway pressure may reduce the risk of postoperative airway complications; and (5) alternative pain management options perioperatively to reduce opioid use should be considered.CONCLUSIONS AND RELEVANCE This consensus contains 35 recommendations and statements on the perioperative care of patients with OSA undergoing UA surgery and may be used as a guideline in daily practice.

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PurposeThe present study examined the internal responsiveness of the short-form Oral Health Impact Profile (OHIP-14) and its ability to differentiate between patients with and without pre- and postoperative complaints as well as other clinical variables.MethodsThe sample consisted of 97 patients undergoing surgical third molar removal. The OHIP-14 was filled in preoperatively, on each postoperative day for a week and once more after 1 month. In addition, pre- and postoperative status was measured along with other clinical variables.ResultsThe OHIP-14 is able to differentiate between the first preoperative day (M = 16.85, SD = 5.35) and all the days within the postoperative week (first day M = 29.46, SD = 9.32). One month postoperatively, mean OHIP scores are reduced to preoperative levels. In addition, differences could be shown between patients with and without pre- (M = 18.9, SD = 8.1 vs. M = 16.2, SD = 3.9) and postoperative complaints (M = 18.9, SD = 8.1 vs. M = 16.2, SD = 3.9), partial (preop; M = 17.8, SD = 6.8, postoperative; M = 27.4, SD = 7.7) and complete mucosa coverage (preop; M = 15.9, SD = 3.2, postoperative; M = 29.5, SD = 10.6) and the level of impaction (Pell and Gregory classification) of the third molar (3B showing the highest increase in the mean OHIP score).ConclusionsThe OHIP-14 can be considered internally responsive to changes in impacts of oral conditions as a result of surgical third molar removal and is able to differentiate the effect of several clinical variables.

Obstructive sleep apnoea (OSA) is challenging medical problem due to its prevalence, its impact on quality of life and performance in school and profession, the implications on risk of accidents and comorbidities and mortality. Current research has carved out a broad spectrum of clinical phenotypes and defined major pathophysiological components. These findings indicate to the concept of personalised therapy, oriented on both the distinct clinical presentation and the most relevant pathophysiology in the individual patient. This leads to the question if sufficient therapeutical options other than positive airway pressure (PAP) alone are available, for which patients they may be useful, if there are specific indications for single or combined treatment, and if there is solid scientific evidence for recommendations. This review describes our knowledge on PAP and non-PAP therapies to address upper airway collapsibility, muscle responsiveness, arousability and respiratory drive. The spectrum is broad and heterogeneous, including technical and pharmaceutical options, already in clinical use or in an advanced experimental stage. Although there is an obvious need for more research on single or combined therapies, the available data demonstrate the variety of effective options, which should replace the unidirectional focus on PAP therapy.

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Obstructive sleep apnea (OSA) on its own, as well as its risk factors, have been found to be associated with the outcome of Coronavirus disease 2019 (COVID-19). However, the association between the degree of OSA and COVID-19 severity is unclear. Therefore, the aim of the study was to evaluate whether or not parameters to clinically evaluate OSA severity and the type of OSA treatment are associated with COVID-19 severity. Patient data from OSA patients diagnosed with COVID-19 were reviewed from outpatients from the Isala Hospital and patients admitted to the Isala Hospital, starting from March until December 2020. Baseline patient data, sleep study parameters, OSA treatment information and hospital admission data were collected. Apnea hypopnea index (AHI), low oxyhemoglobin desaturation (LSAT), oxygen desaturation index (ODI), respiratory disturbance index (RDI), and the type of OSA treatment were regarded as the independent variables. COVID-19 severity–based on hospital or intensive care unit (ICU) admission, the number of days of hospitalization, and number of intubation and mechanical ventilation days–were regarded as the outcome variables. Multinomial regression analysis, binary logistic regression analysis, and zero-inflated negative binomial regression analysis were used to assess the association between the parameters to clinically evaluate OSA severity and COVID-19 severity. A total of 137 patients were included. Only LSAT was found to be significantly associated with the COVID-19 severity (p<0.05) when COVID-19 severity was dichotomized as non-hospitalized or hospitalized and ICU admission or death. Therefore, our findings showed that LSAT seems to be a significant risk factor for COVID-19 severity. However, the degree of OSA–based on AHI, ODI, and RDI–and OSA treatment were not found to be risk factors for COVID-19 severity when looking at hospital or ICU admission, the number of days of hospitalization, and number of intubation and mechanical ventilation days.

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