Improvement in Polysomnographic Objective Sleep Quality in Adults with Pectus Excavatum After the Nuss Procedure

Abstract

Background Patients with pectus excavatum have a poorer subjective sleep quality and quality of life than the general population. The Nuss procedure has been shown to improve these patients' quality of life, but data regarding their postoperative sleep quality are lacking. We aimed to evaluate the objective sleep quality of adults with pectus excavatum before and after the Nuss procedure. Methods Twenty-eight participants completed this study. Epworth Sleepiness Scale (ESS) scores for daytime sleepiness, Pittsburgh Sleep Quality Index (PSQI) scores for subjective sleep quality, and overnight polysomnography for objective sleep quality were evaluated before and 6 months after the Nuss procedure.Results Subjective sleep quality improved after the Nuss procedure. The median PSQI score decreased from 7 [interquartile range (IQR): 5; 9] to 5 (IQR: 4; 7, p = 0.029); the median percentage of poor PSQI sleep quality decreased from 64.3 to 35.7% (p = 0.048). The median percentage of rapid eye movement sleep significantly increased after surgery [15.6% (IQR: 12.2%; 19.8%) vs. 20.4% (IQR: 14.5%; 24.9%), p = 0.016]. Sleep interruptions also improved, with the median arousal index decreasing from 9.5 (IQR: 4.8; 18.2) to 8.2 (IQR: 4.3; 12.1; p = 0.045). However, there was no significant change in ESS scores after surgery (p = 0.955). Conclusions Pectus excavatum may be associated with poor subjective and objective sleep quality in adults, and the condition may improve after the Nuss procedure. For adults with pectus excavatum who report poor subjective sleep quality, polysomnography should be considered to assess their preoperative and postoperative sleep condition. Characteristics Cases (n = 28) Age, years (IQR) 24.0 (22.0; 27.5) Gender Male, n (%) 25 (89.3%) Female, n (%) 3 (10.7%) Body height, cm (IQR) 173 (167; 177.8) Body weight, kg (IQR) 62.5 (55.0; 65.8) Body mass index, kg/m 2 (IQR) 20.2 (18.9; 21.9) Haller index (IQR) 3.6 (3.3; 4.3) Pulmonary function rest FVC, % of predicted value (IQR) 80.0 (69.5; 91.3) FEV1, % of predicted value (IQR) 83.5 (73.5; 91.3) FEV1/FVC, % (IQR) 87.5 (83.3; 91.0) TLC, % of predicted value (IQR) 88.5 (84.0; 96.0) Restrictive lung defect, n (%) 2 (7.1%) Continuous data (age, body height, body weight, body mass index, Haller index) are shown as the median and interquartile range, and categorical data (gender) are shown as a count (%) IQR interquartile range, FVC forced vital capacity, FEV1 forced expiratory volume in 1 s, TLC total lung capacity

A retrospective study on the impact of bar flipping on the recurrence of pectus excavatum after the Nuss procedure

“…Minimally invasive repair of pectus excavatum (MIRPE), Nuss procedure, specially modified to be performed with a thoracoscopic aid [ 8 ] being used to correct pectus excavatum has shown satisfactory long-term results along with a better quality of life in over 90% cases who underwent primary repair, similar to the results of our clinical study[ 6 , 14 , 15 ]. The most common complication of the Nuss procedure is bar placement [ 16 ].…”

Co-existing obstructive sleep apnea reduces Nuss surgery efficacy in pectus excavatum

“…His severe OSA and sternal depression improved after successful surgical treatment for OSA, but it did not correct the PE. In our previous study, we found that AHI in patients with PE did not improve with Nuss surgery [ 15 ]. If co-existing OSA cannot be treated adequately after Nuss surgery, then OSA-related sternal depression will repeatedly occur during sleep and might attenuate the efficacy of the surgery.…”

“…This indicates that OSA is a risk factor for the development of PE; therefore, it is a predictor of surgical failure or PE recurrence. Our previous study [ 15 ] found that co-existing OSA in patients with PE could not be improved after Nuss surgery, suggesting that OSA might be a contributing risk factor for surgical failure or recurrence of PE. Therefore, to address the knowledge gap, this study aimed to evaluate the impact of co-existing OSA on the efficacy of Nuss surgery in patients with PE.…”