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Sleep Apnea Syndromes: HELP
Articles by Srinivas M. Susarla
Based on 10 articles published since 2010
(Why 10 articles?)
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Between 2010 and 2020, S. Susarla wrote the following 10 articles about Sleep Apnea Syndromes.
 
+ Citations + Abstracts
1 Review Biomechanics of the upper airway: Changing concepts in the pathogenesis of obstructive sleep apnea. 2010

Susarla, S M / Thomas, R J / Abramson, Z R / Kaban, L B. ·Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA, USA. ssusarla1@partners.org ·Int J Oral Maxillofac Surg · Pubmed #21030210.

ABSTRACT: Obstructive sleep apnea (OSA) is a disorder characterized by repetitive, episodic collapse of the pharyngeal airway. Over the last two decades, understanding of the pathophysiology of sleep disordered breathing, which includes OSA, has improved. Once thought to be predominately related to anatomic constriction of the maxillomandibular complex, central nervous system regulation of breathing is now recognized as a significant contributor to the pathogenesis of OSA. Ventilator control, the central response to chemoreceptor phenomena, has important implications for oral and maxillofacial surgeons who treat OSA, particularly for patients who appear refractory to treatment with maxillomandibular advancement (MMA). The purpose of this article is to review the biomechanics of the upper airway as it relates to the pathophysiology of OSA, to discuss emerging concepts of ventilator control mechanisms in normal sleep versus sleep-disordered breathing and to discuss the concept of complex sleep apnea, a new category of sleep disordered breathing with both obstructive and central features.

2 Article Subcranial and orthognathic surgery for obstructive sleep apnea in achondroplasia. 2017

Susarla, Srinivas M / Mundinger, Gerhard S / Kapadia, Hitesh / Fisher, Mark / Smartt, James / Derderian, Christopher / Dorafshar, Amir / Hopper, Richard A. ·Craniofacial Center, Division of Plastic and Craniofacial Surgery (Head of Division: Richard A. Hopper), Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA. · Craniofacial Center, Division of Plastic and Craniofacial Surgery (Head of Division: Richard A. Hopper), Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA. Electronic address: Richard.hopper@seattlechildrens.org. ·J Craniomaxillofac Surg · Pubmed #29108917.

ABSTRACT: PURPOSE: Obstructive sleep apnea (OSA) is a common problem in patients with achondroplasia. The purpose of this study was to assess changes in airway volumes following various degrees of facial skeletal advancement. METHODS: This was a retrospective evaluation of patients with achondroplasia who underwent facial skeletal advancement for obstructive sleep apnea. Patients were treated with either an isolated Le Fort III distraction (LF3) or Le Fort II distraction with or without subsequent Le Fort I and bilateral sagittal split osteotomies (LF2 ± LF1/BSSO). Demographic, cephalometric, volumetric, and polysomnographic variables were recorded pre- and postoperatively. RESULTS: Six patients with achondroplasia underwent midface advancement for treatment of OSA (2 LF2 + LF1/BSSO, 2 LF2, 2 LF3). Patients undergoing LF2 + LF1/BSSO had consistent volumetric improvements at the nasopharyngeal and oropharyngeal levels (Δ ≥ +347% and ≥+253%, respectively). Patients undergoing LF2 alone had consistent improvement in the nasopharyngeal airway alone (Δ ≥ +214%). Patients undergoing LF3 alone had consistent, but less dramatic, changes in nasopharyngeal volume (Δ ≥ +97.1%). All patients undergoing LF2 distraction (with or without LF1/BSSO) had a ≥50% reduction in the apnea-hypopnea index (AHI) postoperatively; there was no improvement in AHI with LF3 alone. CONCLUSION: In patients with achondroplasia-associated OSA there are variable improvements in airway volume. This preliminary report suggests that LF2 distraction, with or without subsequent LF1/BSSO, may provide consistent reductions in AHI relative to LF3 distraction.

3 Article Is the Pyriform Ligament Important for Alar Width Maintenance After Le Fort I Osteotomy? 2015

Peacock, Zachary S / Susarla, Srinivas M. ·Assistant Professor, Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Massachusetts General Hospital, Boston, MA. Electronic address: zpeacock@partners.org. · Resident, Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Johns Hopkins Medical School, Baltimore, MD. ·J Oral Maxillofac Surg · Pubmed #26608155.

ABSTRACT: PURPOSE: To determine whether identification and incorporation of the pyriform ligament in the alar cinch results in decreased alar base widening compared with standard alar cinch techniques. MATERIALS AND METHODS: This was a retrospective case series and the sample was composed of patients undergoing Le Fort I osteotomy. Intraoperatively, the pyriform ligament was identified and incorporated in the alar cinch suture. Greatest alar width (GAW) measured immediately after closure was compared with GAW measured at least 5 months postoperatively. The change in alar base width was compared with that reported in the literature using other alar cinch techniques. Two case examples are reported. RESULTS: The sample was composed of 15 patients (mean age, 27.1 yr; 27% female). The mean postoperative change in GAW was 1.0 ± 0.6 mm (2.59 ± 1.59%). Postoperative change in alar base width reported in the literature ranged from 0.5 to 10.8%. CONCLUSION: The pyriform ligament is easily identified during exposure of the maxilla and pyriform aperture and can be used to control widening of the alar base after Le Fort I osteotomy.

4 Article Effects of mandibular distraction osteogenesis on three-dimensional airway anatomy in children with congenital micrognathia. 2013

Abramson, Zachary R / Susarla, Srinivas M / Lawler, Matthew E / Peacock, Zachary S / Troulis, Maria J / Kaban, Leonard B. ·Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA, USA. ·J Oral Maxillofac Surg · Pubmed #22632931.

ABSTRACT: PURPOSE: To assess the 3-dimensional (3D) computed tomography (CT) changes in airway size and shape in children with congenital micrognathia treated by mandibular distraction osteogenesis (DO). PATIENTS AND METHODS: This was a retrospective study of patients with congenital micrognathia, treated by mandibular DO, who had pre- and postoperative 3D maxillofacial CT scans from the hard palate to the hyoid bone. Digital 3D-CT reconstructions were made before and after distraction. Demographic (age, gender, and diagnosis) and anatomic (airway size and shape) variables were recorded and analyzed. The pre-distraction measures of size and shape were compared with the post-distraction measures. P≤.05 was considered significant. RESULTS: During the study period (1999 to 2010), 17 children with congenital micrognathia underwent mandibular DO. Of these patients, 11 (3 females) met the inclusion criteria. The mean age was 6.8 years (range 1.3 to 20.6). All subjects had first and second pharyngeal arch deformities. Nine were tracheostomy dependent before distraction. Postdistraction increases in the anteroposterior diameter (153%), lateral airway diameter (70%), airway volume (76%), minimal retroglossal (162%) and retropalatal (77%), and minimal cross-sectional areas (282%) were obtained. The mean airway length decreased after distraction by 4 mm DO also affected the airway shape: the airway surface area and airway compactness increased after distraction. Six subjects were decannulated or had their tracheostomies capped. Three subjects remained tracheostomy dependent after distraction. The reasons for continued tracheostomy included copious secretions, muscle hypotonia, hypopharnygeal stenosis, and mandibular hypomobility. CONCLUSIONS: DO for congenital micrognathia increases airway size, decreases airway length, and alters the shape as measured using 3D-CT.

5 Article Upper airway length decreases after maxillomandibular advancement in patients with obstructive sleep apnea. 2011

Susarla, Srinivas M / Abramson, Zachary R / Dodson, Thomas B / Kaban, Leonard B. ·Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA 02114, USA. ssusarla1@partners.org ·J Oral Maxillofac Surg · Pubmed #21507540.

ABSTRACT: PURPOSE: Most reports on airway anatomy after maxillomandibular advancement (MMA) for obstructive sleep apnea (OSA) have focused on changes in airway diameter, ie, posterior airway space (PAS), rather than airway length. The purpose of this study was to evaluate changes in cephalometrically measured upper airway length (UAL) after MMA. MATERIALS AND METHODS: This was a retrospective cohort study. The sample was composed of subjects who underwent MMA for OSA. The primary outcome measurement was change in UAL measured on lateral cephalograms. Predictor variables included patient demographic and cephalometric characteristics. Secondary outcome measurements were changes in sleep disturbance. Descriptive, bivariate, and regression statistics were computed. For all analyses, P ≤ .05 was considered statistically significant. RESULTS: The sample included 23 adult subjects (mean age, 39.3 ± 12.1 years; 6 women). Subjects had average maxillary and mandibular advancements of 9.8 ± 2.0 and 10.8 ± 2.2 mm, respectively. Mean pre- and postoperative UALs were 75.8 ± 7.0 and 67.0 ± 5.7 mm, respectively (P < .001). Mean pre- and postoperative respiratory disturbance indexes were 53.2 ± 22.4 and 19.0 ± 12.0 events/hour, respectively (P = .003). All patients had improvement in OSA symptoms, but 3 (13%) required continuous positive airway pressure. CONCLUSION: The results of this study suggest that UAL decreases as a result of MMA. In addition, these results support the observation that MMA is associated with objective and subjective improvements in patients with OSA.

6 Article Three-dimensional computed tomographic airway analysis of patients with obstructive sleep apnea treated by maxillomandibular advancement. 2011

Abramson, Zachary / Susarla, Srinivas M / Lawler, Matthew / Bouchard, Carl / Troulis, Maria / Kaban, Leonard B. ·Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA 02114, USA. ·J Oral Maxillofac Surg · Pubmed #21353929.

ABSTRACT: PURPOSE: To evaluate changes in airway size and shape in patients with obstructive sleep apnea (OSA) after maxillomandibular advancement (MMA) and genial tubercle advancement (GTA). MATERIALS AND METHODS: This was a retrospective cohort study, enrolling a sample of adults with polysomnography-confirmed OSA who underwent MMA + GTA. All subjects who had preoperative and postoperative 3-dimensional computed tomography (CT) scans to evaluate changes in airway size and shape after MMA + GTA were included. Preoperative and postoperative sleep- and breathing-related symptoms were recorded. Descriptive and bivariate statistics were computed. For all analyses, P < .05 was considered statistically significant. RESULTS: During the study period, 13 patients underwent MMA + GTA, of whom 11 (84.6%) met the inclusion criteria. There were 9 men and 2 women with a mean age of 39 years. The mean body mass index was 26.3; mean respiratory disturbance index (RDI), 48.8; and mean lowest oxygen saturation, 80.5%. After MMA + GTA, there were significant increases in lateral and anteroposterior airway diameters (P < .01), volume (P = .02), surface area (P < .01), and cross-sectional areas at multiple sites (P < .04). Airway length decreased (P < .01) and airway shape (P = .04) became more uniform. The mean change in RDI was -60%. CONCLUSIONS: Results of this preliminary study indicate that MMA + GTA appears to produce significant changes in airway size and shape that correlate with a decrease in RDI.

7 Article Cephalometric measurement of upper airway length correlates with the presence and severity of obstructive sleep apnea. 2010

Susarla, Srinivas M / Abramson, Zachary R / Dodson, Thomas B / Kaban, Leonard B. ·Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA 02114, USA. ssusarla1@partners.org ·J Oral Maxillofac Surg · Pubmed #20869147.

ABSTRACT: PURPOSE: The purpose of this study was to measure upper airway length (UAL) on lateral cephalograms and to assess its relationship with the presence and severity of obstructive sleep apnea (OSA). MATERIALS AND METHODS: Using a case-control study design, the investigators enrolled a sample of cases defined as adult subjects with OSA and controls who were adult patients with skeletal Class II malocclusions. The primary predictor variable was UAL. Other variables were demographic and cephalometric parameters. The respiratory disturbance index (RDI) was used to measure disease severity in cases. Bivariate analyses were computed to evaluate the associations between predictor and outcome variables. Multiple regression analyses were used to provide adjusted measures of association, controlling for the effects of confounders/effect modifiers. Diagnostic test characteristics were computed for threshold airway lengths. P ≤ .05 was considered statistically significant. RESULTS: The sample consisted of 96 cases with OSA (76 males) and 56 controls without OSA (36 males). OSA subjects were older, were predominately male, and had higher body mass indexes and longer and narrower airways (P < .05). After controlling for confounding variables, UALs ≥ 72 mm for males and ≥ 62 mm for females were significantly associated with the presence of OSA (P = .03). The sensitivity and specificity of UAL as a diagnostic test for OSA were ≥ 0.8. UAL was strongly correlated with RDI (disease severity) in males (r = 0.72, P < .01) and moderately correlated with RDI in females (r = 0.52, P < .01). CONCLUSION: Increased upper airway length was correlated with the presence and severity of OSA in this sample of adult patients.

8 Article Three-dimensional computed tomographic analysis of airway anatomy. 2010

Abramson, Zachary R / Susarla, Srinivas / Tagoni, James R / Kaban, Leonard. ·Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA, USA. ·J Oral Maxillofac Surg · Pubmed #20116709.

ABSTRACT: PURPOSE: To test the reliability of a 3-dimensional computed tomographic (3D-CT) analysis of airway size and shape and to correlate the 3D-CT findings with lateral cephalometric measurements. MATERIALS AND METHODS: Fifteen pairs of preoperative maxillofacial 3D-CT scans and digital lateral cephalograms of patients treated for obstructive sleep apnea were used in the present study. Digital 3D-CT reconstructions were created and 12 measurements of airway size and 4 of shape were analyzed. The posterior airway space (PAS), middle airway space, and hyoid to mandibular plane distances were measured on the cephalograms. We then randomly selected 5 CT scans and 5 cephalograms which were analyzed blindly on 5 separate occasions by 2 investigators (Z.A., J.T.) to establish the intraclass correlation coefficients for inter- and intraexaminer reliability. All 15 pairs of images were used to compute the Pearson correlation coefficients to establish the relationship between the CT and cephalometric measurements. RESULTS: The intra- and interexaminer reliabilities were high for all CT (0.86 to 1.0 and 0.89 to 1.0, respectively; P < .001) and cephalometric measurements (0.84 to 1.0 and 0.91 to 0.99, respectively; P < .001). The CT measurements retroglossal anteroposterior dimension and distance between the genial tubercle and hyoid exhibited a positive correlation with the PAS (r = .60, P = 02 and r = .54, P = .04, respectively), and the lateral/anteroposterior dimension demonstrated an inverse correlation (r = -.68, P = .01) with the PAS. CONCLUSION: The results of the present study indicate that the 3D-CT and lateral cephalometric measurements we selected are reliable and reproducible. The only cephalometric measurement that exhibited any correlation with the CT parameters was PAS.

9 Article Three-dimensional computed tomographic analysis of airway anatomy in patients with obstructive sleep apnea. 2010

Abramson, Zachary / Susarla, Srinivas / August, Meredith / Troulis, Maria / Kaban, Leonard. ·Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA, USA. ·J Oral Maxillofac Surg · Pubmed #20116708.

ABSTRACT: PURPOSE: To identify abnormalities in airway size and shape that correlate with the presence and severity of obstructive sleep apnea (OSA). MATERIALS AND METHODS: This was a retrospective case series of patients undergoing treatment of OSA who had preoperative computed tomographic (CT) scans of the upper airway available. Patients who had undergone CT scanning for nonairway pathologic features during the same period served as the controls. Digital 3D-CT reconstructions were made and 12 parameters of airway size and 4 of shape were analyzed. The posterior airway space, middle airway space, and hyoid to mandibular plane distance were measured on the lateral cephalograms of the patients with OSA. Bivariate analysis was used to identify the factors associated with the presence and severity of OSA as measured by the respiratory disturbance index (RDI). Multiple regression analysis identified the factors that correlated with the RDI. RESULTS: Of the 44 patients with OSA, 15 (10 men and 5 women) had pre- and postoperative CT scans available. In addition, 17 patients (11 men and 6 women) were used as controls. The airway length was significantly increased in the patients with OSA (P < .01). On bivariate analysis, the length, lateral/retroglossal anteroposterior dimension ratio and genial tubercle to hyoid bone distance were associated with the RDI (P < .03). On multiple regression analysis, length (P < .01) had a positive correlation and the lateral/retroglossal anteroposterior dimension ratio (P = .04) an inverse correlation with the RDI. CONCLUSIONS: The results of this study indicate that the presence of OSA is associated with an increase in airway length. Airways that were more elliptical in shape and mediolaterally oriented (greater lateral/retroglossal anteroposterior dimension ratio) had a decreased tendency toward obstruction.

10 Minor Class II Division II malocclusion does not influence upper airway length. 2011

Susarla, Srinivas M / Abramson, Zachary / Dodson, Thomas B / Kaban, Leonard B. · ·J Oral Maxillofac Surg · Pubmed #21501781.

ABSTRACT: -- No abstract --