New clinical staging for pharyngeal surgery in obstructive sleep apnea patients

Vidigal, Tatiana de Aguiar; Haddad, Fernanda Louise Martinho; Cabral, Rafael Ferreira Pacheco; Oliveira, Maria Claudia Soares; Cavalcante, R.R.; Bittencourt, Lia; Tufik, Sérgio; Gregório, Luiz Carlos

doi:10.1016/j.bjorl.2014.09.003

Cited by 5 publications

(4 citation statements)

References 19 publications

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“…A PT grading scale has been used to predict OSA severity and the efficacy of tonsillectomy in treating OSA. A higher grade, which corresponds with larger and more exophytic tonsils, corresponds with higher preoperative AHI values and a more significant reduction in AHI after removal 1669,1671 . A small series noted improvement in AHI in selected patients with small tonsils after tonsillectomy 1672 .…”

Section: Surgical Treatment For Osamentioning

confidence: 97%

“…A higher grade, which corresponds with larger and more exophytic tonsils, corresponds with higher preoperative AHI values and a more significant reduction in AHI after removal. 1669,1671 A small series noted improve-ment in AHI in selected patients with small tonsils after tonsillectomy. 1672 Jara and Weaver 327 found a strong correlation between the subjective and objective tonsil measures that were consistent with the findings of previous studies, and they suggested that PT grade, rather than volume, may be more predictive of the severity of OSA.…”

Section: Ixd3 Tonsillectomymentioning

confidence: 99%

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International Consensus Statement on Obstructive Sleep Apnea

Chang

Goldberg

Alt

et al. 2023

Int Forum Allergy Rhinol

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Background: Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). Methods: Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidencebased review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. Results: The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. Conclusion:This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.

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Section: Surgical Treatment For Osamentioning

confidence: 97%

Section: Ixd3 Tonsillectomymentioning

confidence: 99%

International Consensus Statement on Obstructive Sleep Apnea

Chang

Goldberg

Alt

et al. 2023

Int Forum Allergy Rhinol

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“…Pharyngeal surgery consisted of tonsillectomy, hemostasis with bipolar electrocautery and 2-0 catgut sutures, closure of muscle and mucosal tissues with interrupted 3-0 Vicryl sutures, detachment of the palatal webbing, and resection of excess uvular mucosa when necessary. The surgical technique has been described in detail by Vidigal et al 15 Nasal surgery (turbinectomy with or without septoplasty) was performed simultaneously with pharyngeal surgery. No nasal packing was used.…”

Section: Methodsmentioning

confidence: 99%

Immediate and Medium-Term Follow-Up of Patients with Obstructive Sleep Apnea Undergoing Pharyngeal and Nasal Surgery: A Pilot Study

et al. 2023

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Objectives To evaluate the evolution of obstructive sleep apnea (OSA), comparing data from preoperative, immediate postoperative and late postoperative, in patients undergoing pharyngeal surgery associated with nasal surgery, and to compare the findings of arterial tonometry and type 1 polysomnography in the late postoperative period. Methods Seventeen adults with moderate or severe OSA were included in the study. They underwent clinical evaluation, surgical intervention, and sleep study preoperatively, on the 1st night after surgery, and after a minimum period of 3 months. The data for the three moments were compared. Results The mean age was 38.1 ± 12.5 years old (22 to 59 years old), and 82.3% were male. Body mass index (BMI) ranged from 25.6 to 45.1 kg/m2 (mean = 33.1 ± 5.8 kg/m2). Fifteen patients (88.2%) were diagnosed with severe OSA. There was a progressive improvement, with a decrease in the indexes (AHI and RDI) and in the percentage of time with peripheral oxyhemoglobin saturation below 90% (tSpO < 90%), and an increase in nadir of SpO2. In the comparison between the 2 methods used in the late postoperative period – arterial tonometry and polysomnography – there was no difference in the indexes and in the tSpO < 90%. Discussion There was a progressive and favorable impact of pharyngeal surgery on the improvement of polysomnographic and clinical respiratory parameters; however, many patients maintained residual OSA, suggesting the need for a new sleep study in the postoperative period. The arterial tonometry showed similar findings to polysomnography, which can be considered as an option in postoperative follow-up of patients.

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“…This includes flow separation, reattachment, and secondary flow vortices (Dean vortices). In parallel with great amount of clinical studies within this field [6][7][8], multidisciplinary approaches that combines medical imaging and numerical modelling techniques have been widely adopted to investigate the interplay between physiology, mechanics and pathophysiology [9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Numerical and Experimental Analysis of Inhalation Airflow Dynamics in a Human Pharyngeal Airway

Fan

Dong

Tian

et al. 2020

IJERPH

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This paper presents a computational and experimental study of steady inhalation in a realistic human pharyngeal airway model. To investigate the intricate fluid dynamics inside the pharyngeal airway, the numerical predicted flow patterns are compared with in vitro measurements using Particle Image Velocimetry (PIV) approach. A structured mesh with 1.4 million cells is used with a laminar constant flow rate of 10 L/min. PIV measurements are taken in three sagittal planes which showed flow acceleration after the pharynx bend with high velocities in the posterior pharyngeal wall. Computed velocity profiles are compared with the measurements which showed generally good agreements with over-predicted velocity distributions on the anterior wall side. Secondary flow patterns on cross-sectional slices in the transverse plane revealed vortices posterior of pharynx and a pair of secondary flow vortexes due to the abrupt cross-sectional area increase. Finally, pressure and flow resistance analysis demonstrate that greatest pressure occurs in the superior half of the airway and maximum in-plane pressure variation is observed at the velo-oropharynx junction, which expects to induce a high tendency of airway collapse during inhalation. This study provides insights of the complex fluid dynamics in human pharyngeal airway and can contribute to a reliable approach to assess the probability of flow-induced airway collapse and improve the treatment of obstructive sleep apnea.

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New clinical staging for pharyngeal surgery in obstructive sleep apnea patients

Cited by 5 publications

References 19 publications

International Consensus Statement on Obstructive Sleep Apnea

International Consensus Statement on Obstructive Sleep Apnea

Immediate and Medium-Term Follow-Up of Patients with Obstructive Sleep Apnea Undergoing Pharyngeal and Nasal Surgery: A Pilot Study

Numerical and Experimental Analysis of Inhalation Airflow Dynamics in a Human Pharyngeal Airway

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