Laryngopharyngeal Reflux Diagnosis in Obstructive Sleep Apnea Patients Using the Pepsin Salivary Test

Iannella, Giannicola; Vicini, Claudio; Polimeni, Antonella; Greco, Antonio; Gobbi, Riccardo Gomes; Montevecchi, Filippo; Vito, Andrea De; Meccariello, Giuseppe; Cammaroto, Giovanni; D’Agostino, Giovanni; Pace, Annalisa; Cascella, Raffaella; Brunori, Marco; Iacono, Cristina Anna Maria Lo; Pelucchi, Stefano; Magliulo, Giuseppe

doi:10.3390/ijerph16112056

Cited by 23 publications

(39 citation statements)

References 37 publications

(109 reference statements)

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“…This results in a reduction in the AHI and an improvement in nighttime saturation. However, an emerging problem related to ventilatory therapy is that between 30% and 50% of patients do not tolerate the device [40][41][42]. This percentage is today also increasing in patients over 65 years old who tend to accept this device less frequently.…”

Section: Discussionmentioning

confidence: 99%

Positional Obstructive Sleep Apnea Syndrome in Elderly Patients

Iannella

Magliulo

Iacono

et al. 2020

IJERPH

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Background The purpose of this study was to evaluate the prevalence of position-dependent obstructive sleep apnea (POSA) in elderly patients (≥65 years old). Adult (range 19-65 years old) and elderly patients were also compared in order to show differences in the incidence of POSA between these two groups of patients. Methods A prospective bi-center study was performed between January 2018 and May 2019. A total of 434 participants underwent polysomnography (PSG) study at home (Embletta MPR). Body position during the PSG recordings was determined. Patients were subdivided in two groups: those aged between 19 and 65 years old (adult patients) and ≥65 years old (elderly patients). POSA patients were defined using Cartwright's system, Bignold classification, and the new Amsterdam Positional OSA Classification (APOC). Results The prevalence of POSA in elderly patients differed according to the classification system used: 49.3% using Cartwright's classification system, 20.5% with the Bignold classification, and 22.6%, 38.9%, and 5.4% of APOC 1, APOC 2, and APOC3 sub-classes were respectively identified for the APOC classification system. No difference between adult and elderly patients regarding the prevalence of POSA was observed. No statistical differences emerged between the two groups of patients in terms of supine (p = 0.9) and non-supine AHI (p = 0.4). Conclusions A significant number of elderly patients could be considered treatable with positional therapy according to the APOC classification. However, the efficacy and applicability of positional therapy in elderly patients must be confirmed by further research.

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Section: Discussionmentioning

confidence: 99%

Positional Obstructive Sleep Apnea Syndrome in Elderly Patients

Iannella

Magliulo

Iacono

et al. 2020

IJERPH

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“…Sticky mucus in the throat was described by 15% of the patients enrolled in the present study. This sensation was related to BMI and was probably due to a laryngopharyngeal reflux, which affects most OSA patients with a high BMI [20].…”

Section: Discussionmentioning

confidence: 96%

“…In the short and long term, the most typical problems reported in these patients were dysphagia, rhinolalia, velopharyngeal insufficiency and nasopharyngeal regurgitation, phlegm in throat, and abnormal scarring with velopharyngeal stenosis [13][14][15][16]. Besides, the tissue resection required for these techniques caused a thick fibrotic scar on the palatal edge that, touching and abrading the base of the tongue, resulted in throat discomfort or foreign body sensation in the throat [17,20,21].…”

Section: Discussionmentioning

confidence: 99%

Long-Term Subjective Outcomes of Barbed Reposition Pharyngoplasty for Obstructive Sleep Apnea Syndrome Treatment

Iannella

Vallicelli

Magliulo

et al. 2020

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Background: The purpose of this study was to evaluate long-term subjective outcomes of barbed reposition pharyngoplasty for obstructive sleep apnea syndrome (OSAS) treatment using a specific questionnaire, the Palate Postoperative Problem Score (PPOPS). Methods: 140 patients who underwent barbed reposition pharyngoplasty (BRP) surgery in the Morgagni Pierantoni Hospital of Forlì, Italy were enrolled in the study. Postoperative outcomes were evaluated in a short- and long-term follow-up using the PPOPS questionnaire. The average period of follow-up was 26 months. All patients received the PPOPS questionnaire by telephone in a period between April and August 2019. Results: 51% of patients complained of swallowing problems after surgery. In 91% of cases, the problem cleared up spontaneously. At the time of the interview, only 9% of patients had a residual swallowing difficult. At the time of PPOPS evaluation, rhinolalia was observed in 8% of patients, whereas nose regurgitation was present in 2% of patients. In 20% of patients, the foreign body sensation was present during follow-up. The value of apnea–hypopnea index (AHI) reduced from the preoperative value of 31.5 to the postoperative value of 11.4. Conclusions: BRP surgery proved to be an effective technique, appreciated by the majority of patients. Use of the PPOPS questionnaire has demonstrated that the BRP technique seems to ensure efficacy and lower morbidity, with few complications after surgery.

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“…66.6% of the patients with clinical LPR tested positive for salivary pepsin. 17 There are a few studies comparing treatment response to salivary pepsin, but none have studied the correlation between pepsin and combined RSI, RFS, and a positive response to treatment. A study by Wang et al noted significant association between strongly positive salivary pepsin and a good treatment response.…”

Section: Discussionmentioning

confidence: 99%

Laryngopharyngeal Reflux: Symptoms, Signs, and Presence of Pepsin in Saliva - A Reliable Diagnostic Triad

Divakaran

Rajendran

Thomas

et al. 2020

Int Arch Otorhinolaryngol

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Abstract Introduction Twenty-four-hour multichannel intraluminal impedance with double probe pH monitoring (MII-pH), though considered the most sensitive tool for the diagnosis of gastroesophageal reflux disease (GERD), is invasive, time consuming, not widely available, and unable to detect non-acid reflux. In contrast, the presence of pepsin in the saliva would act as a marker for reflux, considering that pepsin is only produced in the stomach. Objective To evaluate the predictive value of salivary pepsin in diagnosing laryngopharyngeal reflux (LPR) as suggested by the results of reflux symptom index (RSI > 13), reflux finding score (RFS > 7), and positive response to treatment with a 4-week course of proton-pump inhibitors. Methods This prospective study was done at a tertiary care hospital on 120 adult patients attending ENT OPD with clinical diagnosis of LPR. The presence of pepsin in their pharyngeal secretions and saliva using a lateral flow device, the Peptest, was compared with RSI, RFS, and with the response to medical treatment using the Chi-squared test. Results Salivary pepsin was found to be positive in 68% of the patients, with 87.5% of them showing positive response to treatment. Chi-squared analysis showed a significant association between positive salivary pepsin and RFS > 7, RSI >13, a combination of RFS > 7 and RSI > 13 as well as with response to treatment (p < 0.0001). Conclusion When considered along with the clinical indicators of RFS and RSI of more than 7 and 13, respectively, and/or with a response to treatment, a positive salivary pepsin test indicates statistically significant chance of presence of LPR.

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Laryngopharyngeal Reflux Diagnosis in Obstructive Sleep Apnea Patients Using the Pepsin Salivary Test

Cited by 23 publications

References 37 publications

Positional Obstructive Sleep Apnea Syndrome in Elderly Patients

Positional Obstructive Sleep Apnea Syndrome in Elderly Patients

Long-Term Subjective Outcomes of Barbed Reposition Pharyngoplasty for Obstructive Sleep Apnea Syndrome Treatment

Laryngopharyngeal Reflux: Symptoms, Signs, and Presence of Pepsin in Saliva - A Reliable Diagnostic Triad

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