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Sleep Apnea Syndromes: HELP
Articles from Lousiana
Based on 50 articles published since 2009

These are the 50 published articles about Sleep Apnea Syndromes that originated from Lousiana during 2009-2019.
+ Citations + Abstracts
Pages: 1 · 2
1 Guideline American Cancer Society Head and Neck Cancer Survivorship Care Guideline. 2016

Cohen, Ezra E W / LaMonte, Samuel J / Erb, Nicole L / Beckman, Kerry L / Sadeghi, Nader / Hutcheson, Katherine A / Stubblefield, Michael D / Abbott, Dennis M / Fisher, Penelope S / Stein, Kevin D / Lyman, Gary H / Pratt-Chapman, Mandi L. ·Medical Oncologist, Moores Cancer Center, University of California at San Diego, La Jolla, CA. · Retired Head and Neck Surgeon, Former Associate Professor of Otolaryngology and Head and Neck Surgery, Louisiana State University Health and Science Center, New Orleans, LA. · Program Manager, National Cancer Survivorship Resource Center, American Cancer Society, Atlanta, GA. · Research Analyst-Survivorship, American Cancer Society, Atlanta, GA. · Professor of Surgery, Division of Otolaryngology-Head and Neck Cancer Surgery, and Director of Head and Neck Surgical Oncology, George Washington University, Washington, DC. · Associate Professor, Department of Head and Neck Surgery, Section of Speech Pathology and Audiology, The University of Texas MD Anderson Cancer Center, Houston, TX. · Medical Director for Cancer Rehabilitation, Kessler Institute for Rehabilitation, West Orange, NJ. · Chief Executive Officer, Dental Oncology Professionals, Garland, TX. · Clinical Instructor of Otolaryngology and Nurse, Miller School of Medicine, Department of Otolaryngology, Division of Head and Neck Surgery, University of Miami, Miami, FL. · Vice President, Behavioral Research, and Director, Behavioral Research Center, American Cancer Society, Atlanta, GA. · Co-Director, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, and Professor of Medicine, University of Washington School of Medicine, Seattle, WA. · Director, The George Washington University Cancer Institute, Washington, DC. ·CA Cancer J Clin · Pubmed #27002678.

ABSTRACT: Answer questions and earn CME/CNE The American Cancer Society Head and Neck Cancer Survivorship Care Guideline was developed to assist primary care clinicians and other health practitioners with the care of head and neck cancer survivors, including monitoring for recurrence, screening for second primary cancers, assessment and management of long-term and late effects, health promotion, and care coordination. A systematic review of the literature was conducted using PubMed through April 2015, and a multidisciplinary expert workgroup with expertise in primary care, dentistry, surgical oncology, medical oncology, radiation oncology, clinical psychology, speech-language pathology, physical medicine and rehabilitation, the patient perspective, and nursing was assembled. While the guideline is based on a systematic review of the current literature, most evidence is not sufficient to warrant a strong recommendation. Therefore, recommendations should be viewed as consensus-based management strategies for assisting patients with physical and psychosocial effects of head and neck cancer and its treatment. CA Cancer J Clin 2016;66:203-239. © 2016 American Cancer Society.

2 Review Transoral Robotic Surgery for the Tongue Base. 2019

Ghali, Ghali E / Meram, Andrew T. ·Department of Oral & Maxillofacial Surgery/Head & Neck Surgery, Louisiana State University Health Sciences Center - Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA. · Department of Oral & Maxillofacial Surgery/Head & Neck Surgery, Louisiana State University Health Sciences Center - Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA. Electronic address: ameram@lsuhsc.edu. ·Atlas Oral Maxillofac Surg Clin North Am · Pubmed #30717925.

ABSTRACT: -- No abstract --

3 Review Obstructive Sleep Apnea's Connections with Clinical Dentistry. 2018

Carstensen, Steve. ·Private Practice, Premier Sleep Associates, 636 120th Avenue NE A204, Bellevue, WA 98005, USA; Medmark Media, LLC, Dental Sleep Practice Magazine, 15720 N. Greenway Hayden Loop, Suite 9, Scottsdale, AZ 85260, USA; The Pankey Institute, One Crandon Boulevard Key Biscayne, FL 33149, USA; Louisiana State University Health Continuing Dental Education, 1100 Florida Avenue, New Orleans, LA 70119, USA; Department of Continuing Dental Education, The University of the Pacific, San Francisco, CA, USA; Spear Education, 7201 E Princess Boulevard, Scottsdale, AZ 85255, USA. Electronic address: SeattleSleepEd@gmail.com. ·Sleep Med Clin · Pubmed #30396446.

ABSTRACT: Adding airway services to a dental practice disrupts scheduling, examinations, treatment planning, billing, and team roles. Problems connected with the airway can be addressed with more precise therapy and better prognosis while building confidence between the patient and the dental team. Each team member must understand the connections between airway problems and patient health and be able to talk about it with confidence. If the entire team supports the inclusion of airway therapy into the service mix, patients will feel well cared for and rewards to the office will be plentiful.

4 Review Adenotonsillectomy for Obstructive Sleep Apnea and Quality of Life: Systematic Review and Meta-analysis. 2017

Todd, Cameron A / Bareiss, Anna K / McCoul, Edward D / Rodriguez, Kimsey H. ·1 Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA. · 2 Department of Otorhinolaryngology-Head and Neck Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA. · 3 Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, Louisiana, USA. ·Otolaryngol Head Neck Surg · Pubmed #28675097.

ABSTRACT: Objective To determine the impact of adenotonsillectomy on the quality of life of pediatric patients with obstructive sleep apnea (OSA) and to identify gaps in the current research. Data Sources The MEDLINE, EMBASE, and Cochrane databases were systematically searched via the Ovid portal on June 18, 2016, for English-language articles. Review Methods Full-text articles were selected that studied boys and girls <18 years of age who underwent adenotonsillectomy for OSA or sleep-disordered breathing and that recorded validated, quantitative quality-of-life outcomes. Studies that lacked such measures, performed adenotonsillectomy for indications other than OSA or sleep-disordered breathing, or grouped adenotonsillectomy with other procedures were excluded. Results Of the 328 articles initially identified, 37 were included for qualitative analysis. The level of evidence was generally low. All studies involving short-term follow-up (≤6 months) showed improvement in quality-of-life scores after adenotonsillectomy as compared with preoperative values. Studies involving long-term follow-up (>6 months) showed mixed results. Modifications to and concurrent procedures with conventional adenotonsillectomy were also identified that showed quality-of-life improvements. Three studies were identified for meta-analysis that compared pre- and postoperative Obstructive Sleep Apnea-18 scores. Short- and long-term follow-up versus preoperative scores showed significant improvement ( P < .001). Short- and long-term scores showed no significant difference. Conclusion This systematic review and meta-analysis demonstrate adenotonsillectomy's effectiveness in improving the quality of life of pediatric patients with OSA. This is well demonstrated in the short term and has strong indications in the long term.

5 Review Weight Loss and Improvement in Comorbidity: Differences at 5%, 10%, 15%, and Over. 2017

Ryan, Donna H / Yockey, Sarah Ryan. ·Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA, 70808, USA. ryandh@pbrc.edu. · Department of Obstetrics and Gynecology, LSU School of Medicine, 1542 Tulane Avenue, New Orleans, LA, USA. ·Curr Obes Rep · Pubmed #28455679.

ABSTRACT: PURPOSE OF REVIEW: One begins to see improvement in glycemic measures and triglycerides with small amounts of weight loss, but with greater levels of weight loss there is even greater improvement. In fact, the relationship between weight loss and glycemia is one that is very close. RECENT FINDINGS: This is fortunate for diabetes prevention; it takes only small amounts of weight loss to prevent progression to type 2 diabetes from impaired glucose tolerance, and after the 10 kg of weight loss, one cannot demonstrate much additional improvement in risk reduction. Modest weight loss (5 to 10%) is also associated with improvement in systolic and diastolic blood pressure and HDL cholesterol. With all these risk factors, more weight loss produces more improvement. Further, for patients with higher BMI levels (>40 kg/m

6 Review Advanced airway management strategies for severe OSAS and craniofacial anomalies. 2017

Gungor, Anil. ·Department of Otolaryngology Head & Neck Surgery, Louisiana State University School of Medicine, Shreveport, LA. Electronic address: entforkids@yahoo.com. ·Am J Otolaryngol · Pubmed #27756487.

ABSTRACT: Pediatric OSAS and craniofacial malformations present challenges that require innovative approaches and comprehensive treatment strategies. Synchronous airway lesions, craniofacial malformations, obstructive anomalies of the tongue base, nasal vault and choanae are commonly addressed by subspecialists from various clinical and surgical academic traditions who practice variable levels of required communication. This is not a mere social requirement but an important requisite for intelligent and effective airway management. Membership of dedicated airway, aero digestive or craniofacial teams are desirable but not required. I expect this clinical brief to help many brilliant clinicians in their pursuit of perfection.

7 Review Treatment Options for Pediatric Obstructive Sleep Apnea. 2016

Cielo, Christopher M / Gungor, Anil. ·Division of Pulmonary Medicine, The Children׳s Hospital of Philadelphia. · Department of Otolaryngology, Louisiana State University Shreveport. Electronic address: agungo@lsuhsc.edu. ·Curr Probl Pediatr Adolesc Health Care · Pubmed #26597557.

ABSTRACT: There are a variety of therapies available for the treatment of pediatric obstructive sleep apnea syndrome (OSAS). In children with enlarged adenoids or tonsils, adenotonsillectomy (AT) is the preferred treatment, but other surgical options include partial tonsillectomy and lingual tonsillectomy. In specific populations, craniofacial or bariatric surgery may be indicated, and tracheostomy should be reserved for cases where there is no other therapeutic option. Positive airway pressure (PAP) is the most effective non-surgical therapy for OSAS as it can be successfully used in even cases of severe OSAS. Nasal steroids and leukotriene receptor antagonists may be used in the treatment of mild or moderate OSAS. Rapid maxillary expansion and dental appliances may be effective in select populations with dental problems. Other non-surgical therapies, such as positional therapy, supplemental oxygen, and weight loss have not been shown to be effective in most pediatric populations.

8 Review Obstructive sleep apnea and hypertension: is the primary link simply volume overload? 2013

Owen, Jonathan / Reisin, Efrain. ·Section of Nephrology and Hypertension, Louisiana State University Health Sciences Center, 1542 Tulane Ave, New Orleans, LA 70113, USA. ·Curr Hypertens Rep · Pubmed #23564014.

ABSTRACT: -- No abstract --

9 Review Atrial fibrillation in the 21st century: a current understanding of risk factors and primary prevention strategies. 2013

Menezes, Arthur R / Lavie, Carl J / DiNicolantonio, James J / O'Keefe, James / Morin, Daniel P / Khatib, Sammy / Milani, Richard V. ·Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA 70121-2483, USA. ·Mayo Clin Proc · Pubmed #23541013.

ABSTRACT: Atrial fibrillation (AF) is the most common arrhythmia worldwide, and it has a significant effect on morbidity and mortality. It is a significant risk factor for stroke and peripheral embolization, and it has an effect on cardiac function. Despite widespread interest and extensive research on this topic, our understanding of the etiology and pathogenesis of this disease process is still incomplete. As a result, there are no set primary preventive strategies in place apart from general cardiology risk factor prevention goals. It seems intuitive that a better understanding of the risk factors for AF would better prepare medical professionals to initially prevent or subsequently treat these patients. In this article, we discuss widely established risk factors for AF and explore newer risk factors currently being investigated that may have implications in the primary prevention of AF. For this review, we conducted a search of PubMed and used the following search terms (or a combination of terms): atrial fibrillation, metabolic syndrome, obesity, dyslipidemia, hypertension, type 2 diabetes mellitus, omega-3 fatty acids, vitamin D, exercise toxicity, alcohol abuse, and treatment. We also used additional articles that were identified from the bibliographies of the retrieved articles to examine the published evidence for the risk factors of AF.

10 Review The association between sleep-disordered breathing and enuresis in children. 2012

Jeyakumar, Anita / Rahman, Syed I / Armbrecht, Eric S / Mitchell, Ron. ·Department of Otorhinolaryngology, Louisiana State University-Health Science Center, New Orleans, Louisiana, USA. ajeyak@lsuhsc.edu ·Laryngoscope · Pubmed #22549900.

ABSTRACT: OBJECTIVES/HYPOTHESIS: To evaluate the prevalence of nocturnal enuresis in children diagnosed with sleep disordered breathing (SDB) and the effect of adenotonsillectomy (T&A) on nocturnal enuresis. STUDY DESIGN: Systematic review of the literature. METHODS: Systematic review of the literature was performed using PubMed and Ovid. A systematic analysis of the literature was performed from 1980 to 2010 to identify children who had SDB and enuresis. A subset of children with enuresis who underwent T&A for SDB were also studied. RESULTS: A total of 14 studies were reviewed. A total of 3,550 children had SDB, of which one-third (n = 1,113) had a diagnosis of enuresis. Age range was 18 months to 19 years. Seven studies (n =1,360) had data on patients who underwent T&A for SDB with follow-up data on enuresis. The mean sample size was 194, with a median follow-up of 6 months and age range of 2 to 18 years. Preoperative prevalence of enuresis was 31% (426/1,360). A total of 587 children were followed after T&A. The postoperative prevalence of enuresis was 16% (95/587; P < .0002, two-tailed). Most studies did not make a distinction between primary and secondary enuresis. The age range of the subjects (18 months to 19 years) likely included some patients with developmentally acceptable enuresis. CONCLUSIONS: SDB in children is associated with nocturnal enuresis. T&A is associated with a significant improvement in enuresis in children with SDB. There is a need for randomized controlled trials to look at the role of T&A in children with SDB and enuresis.

11 Clinical Trial The efficacy of a chinstrap in treating sleep disordered breathing and snoring. 2014

Bhat, Sushanth / Gushway-Henry, Neola / Polos, Peter G / DeBari, Vincent A / Riar, Sandeep / Gupta, Divya / Lysenko, Liudmila / Patel, Disha / Pi, Justin / Chokroverty, Sudhansu. ·NJ Neuroscience Institute at JFK Medical Center/Seton Hall University, Edison NJ; · Seton Hall University School of Health and Medical Sciences, South Orange, NJ; · JFK Medical Center, Edison, NJ; · Ochsner Health Systems, New Orleans, LA; · Hackensack University Medical Center, Hackensack NJ. ·J Clin Sleep Med · Pubmed #25126035.

ABSTRACT: STUDY OBJECTIVES: A previously published case report suggested that a chinstrap alone might improve obstructive sleep apnea (OSA). We conducted this study to determine whether a chinstrap was a feasible alternative to continuous positive airway pressure (CPAP) in patients with OSA. METHODS: 26 adult patients with OSA (apnea-hypopnea index [AHI] > 5/h on diagnostic polysomnogram [PSG]) underwent a modified split-night PSG, using only a chinstrap for the first 2 hours of sleep, followed by CPAP titration for the remainder of the night. Improvements in AHI, arterial oxygen saturation (SpO2), and snoring with chinstrap use were compared to results with optimal CPAP pressures. RESULTS: There was no significant difference between the diagnostic PSG and the chinstrap portion of the split-night PSG in the following parameters: general AHI (median [IQR] 16.0/h [9.7-26.0] vs. 25.9/h [10.7-42.7]), SpO2 nadir (84.0% [80.5-87.5] vs. 87.0 [84.0-88.5]), AHI in REM sleep (26.7/h [16.8-43.7] vs. 42.4/h [21.3-57.7]), AHI in supine sleep (24.9/h [11.9-51.5] vs. 29.8/h [11.7-55.5]), snoring index (253.2/h [147.5-353.1] vs. 180.0/h [9.8-393.3]) or subjective snoring scale (3.0 [0.8-3.0] vs. 2.5 [0.4-3.0]). The AHI and SpO2 nadir in the 13 patients with mild OSA also did not improve with chinstrap use (9.6/h [8.1-12.2] vs. 10.6/h [6.8-35.4] and 87.0% [83.0-90.0] vs. 88.0% [87.0-89.0]). All these parameters showed significant improvement with optimal CPAP titration (p < 0.05). CONCLUSIONS: A chinstrap alone is not an effective treatment for OSA. It does not improve sleep disordered breathing, even in mild OSA, nor does it improve the AHI in REM sleep or supine sleep. It is also ineffective in improving snoring.

12 Clinical Trial Spironolactone reduces severity of obstructive sleep apnoea in patients with resistant hypertension: a preliminary report. 2010

Gaddam, K / Pimenta, E / Thomas, S J / Cofield, S S / Oparil, S / Harding, S M / Calhoun, D A. ·Division of Cardiovascular Diseases, Ochsner Clinic Foundation, New Orleans, LA, USA. ·J Hum Hypertens · Pubmed #20016520.

ABSTRACT: Obstructive sleep apnoea (OSA) and hyperaldosteronism are very common in subjects with resistant hypertension. We hypothesized that aldosterone-mediated chronic fluid retention may influence OSA severity in patients with resistant hypertension. We tested this in an open-label evaluation by assessing the changes in the severity of OSA in patients with resistant hypertension after treatment with spironolactone. Subjects with resistant hypertension (clinical blood pressure (BP) >or=140/90 mm Hg on >or=3 antihypertensive medications, including a thiazide diuretic and OSA (defined as an apnoea-hypopnoea index (AHI) >or=15) had full diagnostic, polysomnography before and 8 weeks after spironolactone (25-50 mg a day) was added to their ongoing antihypertensive therapy. In all, 12 patients (mean age 56 years and body mass index 36.8 kg m(-2)) were evaluated. After treatment with spironolactone, the AHI (39.8+/-19.5 vs 22.0+/-6.8 events/h; P<0.05) and hypoxic index (13.6+/-10.8 vs 6.7+/-6.6 events/h; P<0.05), weight and clinic and ambulatory BP were significantly reduced. Plasma renin activity (PRA) and serum creatinine were significantly higher. This study provides preliminary evidence that treatment with a mineralocorticoid receptor antagonist substantially reduces the severity of OSA. If confirmed in a randomized assessment, it will support aldosterone-mediated chronic fluid retention as an important mediator of OSA severity in patients with resistant hypertension.

13 Article Restoration of sleep using a novel biomimetic protocol for adult OSA: Clinical case report. 2019

Singh, G Dave / Kraver, Mark / Chernyshev, Oleg. ·a Vivos BioTechnologies, Inc. , Cedar Crest , NM , USA. · b Cape Dental Care , Cape Coral , FL , USA. · c Neurology and Sleep Medicine , Louisiana State University , Shreveport , LA , USA. ·Cranio · Pubmed #29448905.

ABSTRACT: BACKGROUND: A sleep study of a 56-year old male with excessive daytime sleepiness demonstrated an AHI of 16.4hr CLINICAL PRESENTATION: On intra-oral examination, it was found that the patient had maxillary hypoplasia and bilateral torus mandibularis. A 3D cone-beam CT (CBCT) scan was taken, and 28 craniofacial parameters were measured. Surgical reduction of the mandibular tori followed by biomimetic oral appliance therapy (BOAT) was initiated. After 14 months, a post-treatment CBCT scan revealed that 70% of parameters measured had improved. Therefore, another sleep study was performed with no device in the mouth. This follow-up home sleep test demonstrated that the AHI fell to 5.3hr CONCLUSION: These findings suggest that BOAT might be able to restore sleep in certain adult cases.

14 Article High risk for obstructive sleep apnea hypopnea syndrome predicts new onset atrial fibrillation after cardiac surgery: a retrospective analysis. 2018

Patel, Samir V / Gill, Harmeet / Shahi, Diwas / Rajabalan, Ajai / Patel, Palak / Sonani, Rajesh / Bhatt, Parth / Rodriguez, Rafael David / Bautista, Manuel / Deshmukh, Abhishek / Gonzalez, Juan Viles / Patel, Sanjay. ·Department of Medicine, Sparks Health Systems, Fort Smith, AR, USA. samir.drsam@gmail.com. · Department of Medicine, Western Reserve Health Education/NEOMED, Youngstown, OH, USA. samir.drsam@gmail.com. · Department of Medicine, Western Reserve Health Education/NEOMED, Youngstown, OH, USA. · Department of Medicine, Palmetto Health, University of South Carolina School of Medicine, Columbia, SC, USA. · Department of Health Sciences, Massachusetts College of Pharmacy and Health Sciences, Manchester, NH, USA. · Department of Medicine, Brandon Regional Medical Center, Brandon, FL, USA. · Department of Pediatrics, Texas Tech Health Sciences Center, Amarillo, TX, USA. · Department of Medicine, Medical University of South Carolina, Charleston, SC, USA. · Department of Cardiology, Mayo Clinic, Rochester, MN, USA. · Department of Cardiology, Tulane University, New Orleans, LA, USA. · Department of Pulmonary and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA. ·Sleep Breath · Pubmed #29460195.

ABSTRACT: PURPOSE: Obstructive sleep apnea hypopnea syndrome (OSAHS) is highly prevalent in patients undergoing coronary artery bypass surgery (CABG). OSAHS is a risk factor for the development of atrial fibrillation (AF), but the risk of AF in patients who are high risk for OSAHS is unclear. METHODS: A retrospective study was conducted on consecutive patients undergoing CABG from 2013 to 2015 without AF pre-operatively. Patients were categorized as low risk for OSAHS, high risk for OSAHS, or diagnosed OSAHS based on medical records review. All diagnosed OSAHS patients were on active treatment with positive airway pressure. Outcomes assessed were postoperative AF (POAF), postoperative length of stay, re-intubation, in-hospital mortality, and cost of hospitalization. RESULTS: Out of 209 eligible patients, 66.5% were low-risk for OSAHS, 18.7% high-risk for OSAHS, and 14.8% diagnosed/treated for OSAHS. POAF developed in 96 patients (45.9%) with greater frequency in high-risk OSAHS patients (69.2% high risk, 41.9% low risk, 40.3% diagnosed/treated, p = 0.01). In analyses adjusted for age, sex, ethnicity and comorbidities, high risk for OSAHS was associated with 2.9 greater odds (95% CI [1.2, 7.3], p = 0.02) for POAF while diagnosed/treated OSAHS was not associated with elevated risk (OR = 1.4, 95% CI [0.6, 3.6], p = 0.50) compared to patients at low risk for OSAHS. CONCLUSIONS: High risk for OSAHS is an independent predictor for POAF in patients undergoing CABG. In contrast, patients diagnosed and treated for their OSAHS are not at elevated risk of POAF. These findings support evaluation of a standardized OSAHS screening and treatment program as part of the pre-operative evaluation for elective CABG.

15 Article The effectiveness of two types of MADS for OSA therapy. 2018

Verburg, Francis Emma / Bollen, Klara Hilda Alphonsine / Donker, Henk-Jan / Kramer, Gerbrand Johannes Cornelis. ·Dentist cabinet Egmond, 1931, GB, Egmond aan Zee, the Netherlands. · Department of Orthodontics, Academic Centre of Dentistry Amsterdam (ACTA), Floor 4, Gustav Mahlerlaan 3004, 3004 1081, LA, Amsterdam, the Netherlands. bollenklara@gmail.com. · Department of Orthodontics, North West Clinics, Medical Centre Alkmaar (MCA), Wilhelminalaan 12, 1815, JD, Alkmaar, the Netherlands. · Department of Orthodontics, Academic Centre of Dentistry Amsterdam (ACTA), Floor 4, Gustav Mahlerlaan 3004, 3004 1081, LA, Amsterdam, the Netherlands. ·Clin Oral Investig · Pubmed #29214378.

ABSTRACT: OBJECTIVES: The purpose of this study was to determine differences in effectiveness between two types of mandibular advancement device (MAD). MATERIAL AND METHODS: In this retrospective, cohort study, the two devices used were MAD type "Somnodent-Flex" (MAD 1) and MAD type "Herbst" (MAD 2). One hundred thirty-seven patients participated in this study, 67 patients were treated with MAD 1, and 70 patients with MAD 2. The indication MAD with obstructive sleep apnea (OSA) is based on a polysomnography test, in accordance with the CBO guidelines. The effectiveness of MAD therapy can be determined by a second polysomnography test (with the MAD in situ). The apnea-hypopnea index (AHI) is registered during the first and the second polysomnography test. Changes in these values determine the effectiveness. RESULTS: A significant decrease in AHI was found regarding T1 and T2 for both the MADs: F (1, 134) = 140,850, p < 0,001. The mean differences of both the MADs turned out to correlate to T1. After correcting for this covariance, there was no significant difference between the two MAD devices regarding the AHI value: F (1, 134) = 1160, p = 0,283. CONCLUSIONS: The results of the present study show no significant difference in effectiveness between MAD 1 and MAD 2 in respect to the AHI value. CLINICAL RELEVANCE: Since 2012, healthcare insurance companies in the Netherlands refunds MAD type "Somnodent" used for treatment of sleep apnea. It is important to investigate if this type of MAD is as more effective or less effective as other types of MADs. If research points out that other MADs are more effective in reducing the sleep apnea, refund policies have to be adapted.

16 Article Tracheostomy for Severe Pediatric Obstructive Sleep Apnea: Indications and Outcomes. 2017

Rizzi, Christopher J / Amin, Julian D / Isaiah, Amal / Valdez, Tulio A / Jeyakumar, Anita / Smart, Suzanne E / Pereira, Kevin D. ·1 Deparment of Otorhinolaryngology-Head and Neck Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA. · 2 Deparment of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas, USA. · 3 Department of Otolaryngology-Head and Neck Surgery, Connecticut Children's Medical Center, Hartford, Connecticut, USA. · 4 Department of Otorhinolaryngology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA. ·Otolaryngol Head Neck Surg · Pubmed #28417683.

ABSTRACT: Objectives (1) To describe characteristics of pediatric patients undergoing tracheostomy for obstructive sleep apnea (OSA). (2) To highlight perioperative events and outcomes of the procedure. Study Design Case series with chart review. Setting Four tertiary care academic children's hospitals. Subjects and Methods Twenty-nine children aged <18 years from January 1, 2010, to December 31, 2015, who underwent tracheostomy for severe OSA, defined as an apnea-hypopnea index (AHI) >10, were included in the study. Data on patient characteristics, polysomnographic findings, comorbidities, and perioperative events and outcomes were collected and analyzed. Results Twenty-nine patients were included. Mean age at tracheostomy was 2.0 years (95% CI, -2.2 to 6.2). Mean body mass index z score was -1.2 (95% CI, -4.9 to -2.5). Mean preoperative AHI was 60.2 (95% CI, -15.7 to 136.1). Mean postoperative intensive care unit stay was 23.2 days (95% CI, 1.44-45.0). One procedure was complicated by bronchospasm. Thirteen patients had craniofacial abnormalities; 10 had a neurologic disorder resulting in hypotonia; and 5 had a diagnosis of laryngomalacia. Mean follow-up was 30.6 months (95% CI, -10.4 to 71.6). Six patients were decannulated, with a mean time to decannulation of 40.8 months (95% CI, 7.9-73.7). Five patients underwent capped sleep study prior to decannulation with a mean AHI of 6.6 (95% CI, -9.9 to 23.1) and a mean oxygen nadir of 90.0% (95% CI, 80%-100%). Conclusion OSA is an uncommon indication for tracheostomy in children. Patients who require the procedure usually have an associated syndromic diagnosis resulting in upper airway obstruction. The majority of children who undergo tracheostomy for OSA will remain dependent at 24 months.

17 Article Unusual case of sleep apnea in a child. 2017

Duffy, Lisa / Jeyakumar, Anita. ·Children's Hospital, New Orleans, LA, USA. ·Ear Nose Throat J · Pubmed #28346639.

ABSTRACT: -- No abstract --

18 Article Utility of polysomnography in determination of laryngomalacia severity. 2017

Weinstein, Jacqueline E / Lawlor, Claire M / Wu, Eric L / Rodriguez, Kimsey H. ·Tulane University School of Medicine, Department of Otolaryngology/Head and Neck Surgery, New Orleans, LA, USA. · Tulane University School of Medicine, Department of Otolaryngology/Head and Neck Surgery, New Orleans, LA, USA. Electronic address: clawlor@tulane.edu. · Tulane University School of Medicine, Department of Otolaryngology/Head and Neck Surgery, New Orleans, LA, USA; Ochsner Clinic Foundation, Department of Pediatric Otolaryngology, New Orleans, LA, USA. ·Int J Pediatr Otorhinolaryngol · Pubmed #28109487.

ABSTRACT: OBJECTIVE: To examine the efficacy of polysomnography in determining the severity of laryngomalacia in pediatric patients. METHODS: Prospective cohort study. Pediatric patients referred to our pediatric otolaryngology department with a polysomnogram already performed for a presumptive diagnosis of laryngomalacia were enrolled in the study. Patients with concurrent airway lesions or neuromuscular disorders were excluded. Patients underwent history, physical exam, and flexible fiberoptic laryngoscopy. These results were used to calculate a total laryngomalacia severity score. RESULTS: 25 pediatric patients (n = 25) with an average age of 3.9 months at time of initial evaluation met criteria for enrollment in our study. 100% of patients had obstructive sleep apnea by definition. 80% of these patients underwent supraglottoplasty. The average AHI of those who underwent surgery (57.26) was not significantly different in those who underwent surgery vs. those that did not (55.43) (p = 0.41). In comparison, the average laryngomalacia severity score based from history, physical exam and flexible laryngoscopy was significantly greater in the patients that required supraglottoplasty (11.16) vs. those who did not (5.33) (p = 0.03). In addition a higher laryngomalacia severity score was not correlated with a higher AHI (p = 0.81, r = 0.08, CI: -0.5197 to 0.6235). CONCLUSION: In our cohort, polysomnography was not useful in determining the severity of laryngomalacia, did not correlate with the clinical evaluation, and alone was not predictive of the patients that would require surgical intervention. History, physical exam, and endoscopic findings remain reliable predictors of disease severity and need for operative intervention.

19 Article Incorporating body-type (apple vs. pear) in STOP-BANG questionnaire improves its validity to detect OSA. 2017

Sangkum, Lisa / Klair, Ikrita / Limsuwat, Chok / Bent, Sabrina / Myers, Leann / Thammasitboon, Supat. ·Department of Anesthesiology, Tulane University Health Sciences Center, New Orleans, LA, United States. Electronic address: lisa.sangkum@gmail.com. · Department of Pulmonary disease, Critical Care, and Environmental Medicine, Tulane University Health Sciences Center, New Orleans, LA, United States. Electronic address: klair_ikrita@hotmail.com. · Department of Pulmonary disease, Critical Care, and Environmental Medicine, Tulane University Health Sciences Center, New Orleans, LA, United States. Electronic address: climsuwa@tulane.edu. · Department of Anesthesiology, Tulane University Health Sciences Center, New Orleans, LA, United States. Electronic address: sbent1@tulane.edu. · Department of Biostatistics & Bioinformatics, Tulane University Health Sciences Center, New Orleans, LA, United States. Electronic address: myersl@tulane.edu. · Department of Pulmonary disease, Critical Care, and Environmental Medicine, Tulane University Health Sciences Center, New Orleans, LA, United States. Electronic address: sthammas@tulane.edu. ·J Clin Anesth · Pubmed #28077252.

ABSTRACT: STUDY OBJECTIVE: The aim of this study is to evaluate whether adding the item of "apple body type" to the STOP-BANG questionnaire enhances diagnostic performance of the questionnaire for detecting obstructive sleep apnea (OSA). DESIGN: Cross-sectional study. SETTING: Sleep center setting. PATIENTS: Two hundred and eight subjects who were referred for an evaluation of possible OSA at Tulane Comprehensive Sleep Center. The exclusion criteria were age<18years old, incomplete or absent questionnaire, incomplete body type identification, polysomnography (PSG) refusal, and pregnant women. INTERVENTIONS: STOP-BANG items and body type data were collected on the initial clinic visit. An overnight PSG was performed on every participant. MEASUREMENTS: Descriptive analyses of the demographic data and PSG variables were performed. The predictive parameters of STOP and STOP-BANG without and with body type score (STOP-Apple and STOPBANG-Apple) were compared. MAIN RESULTS: The STOP questionnaire's sensitivity/specificity/positive likelihood ratio (+LR) (cut-off=2) was 96%/11%/1.1, respectively whereas the STOP-Apple questionnaire (cut-off=3) was 88%/39%/1.5. The STOP-BANG's sensitivity/specificity/+LR (cut-off=3) was 96%/19%/1.2, respectively whereas the STOP-BANG-Apple questionnaire (cut-off=4) was 90%/39%/1.5. The area under the Receiver Operating Characteristic (ROC) curve of STOP-Apple was comparable to the STOP-BANG (P=0.25). The addition of the apple body type item to the STOP-BANG questionnaire in participants with a score≥3 led to increased specificity (67.4%), increased the odds ratio of having OSA of 2.5 (95% CI, 1.2-5.3) and odds ratio of having moderate-severe OSA of 4.7 (95% CI, 2.5-8.7). CONCLUSION: In the sleep center setting, adding the body type item to the STOP-BANG questionnaire improves not only clinical prediction for PSG confirmed OSA but also predicts moderate to severe of OSA.

20 Article Ventilatory Cycle Measurements and Loop Gain in Central Apnea in Mining Drivers Exposed to Intermittent Altitude. 2017

Rey de Castro, Jorge / Liendo, Alicia / Ortiz, Oswaldo / Rosales-Mayor, Edmundo / Liendo, César. ·Clínica Anglo Americana, Lima-Perú, School Medicine Professor, Universidad Peruana Cayetano Heredia, Lima-Perú. · University of Medicine and Health Sciences-St. Kitts, WI. · Individual Member of the International Council of Occupational Health. · CIBERES, IDIBAPS, Respiratory Disease Department, Instituto Clínic del Tórax, Hospital Clínic de Barcelona, Barcelona, Spain. · Multidisciplinary Sleep Clinic, Louisiana State University, Shreveport, LA; Clinical and Sleep Laboratory Director VAMC, Shreveport, LA. ·J Clin Sleep Med · Pubmed #27707449.

ABSTRACT: STUDY OBJECTIVES: By measuring the apnea length, ventilatory phase, respiratory cycle length, and loop gain, we can further characterize the central apneas of high altitude (CAHA). METHODS: Sixty-three drivers of all-terrain vehicles, working in a Peruvian mine located at 2,020 meters above sea level (MASL), were evaluated. A respiratory polygraph was performed in the first night they slept at high altitude. None of the subjects were exposed to oxygen during the test or acetazolamide in the preceding days of the test. RESULTS: Sixty-three respiratory polygraphs were performed, and 59 were considered for analysis. Forty-six (78%) were normal, 6 (10%) had OSA, and 7 (12%) had CAHA. Key data from subjects include: residing altitude: 341 ± 828 MASL, Lake Louise scoring: 0.4 ± 0.8, Epworth score: 3.4 ± 2.7, apneahypopnea index: 35.7 ± 19.3, CA index: 13.4 ± 14.2, CA length: 14.4 ± 3.6 sec, ventilatory length: 13.5 ± 2.9 sec, cycle length: 26.5 ± 4.0 sec, ventilatory length/CA length ratio 0.9 ± 0.3 and circulatory delay 13.3 ± 2.9 sec. Duty ratio media [ventilatory duration/cycle duration] was 0.522 ± 0 0.128 [0.308-0.700] and loop gain was calculated from the duty ratio utilizing this formula: LG = 2π / [(2πDR-sin(2πDR)]. All subjects have a high loop gain media 2.415 ± 1.761 [1.175-6.260]. Multiple correlations were established with loop gain values, but the only significant correlation detected was between central apnea index and loop gain. CONCLUSIONS: Twelve percent of the studied population had CAHA. Measurements of respiratory cycle in workers with CAHA are more similar to idiopathic central apneas rather than Hunter-Cheyne-Stokes respiration. Also, there was a high degree of correlation between severity of central apnea and the degree of loop gain. The abnormal breathing patterns in those subjects could affect the sleep quality and potentially increase the risk for work accidents.

21 Article Obstructive sleep apnoea and the need for its introduction into dental curricula. 2017

Güneri, P / İlhan, B / Çal, E / Epstein, J B / Klasser, G D. ·Department of Oral and Maxillofacial Radiology, Ege University School of Dentistry, Izmir, Turkey. · Department of Prosthetic Dentistry, Ege University School of Dentistry, Izmir, Turkey. · Division of Otolaryngology and Head and Neck Surgery City of Hope National Medical Center, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA. · Department of Diagnostic Sciences, School of Dentistry, Louisiana State University, New Orleans, LA, USA. ·Eur J Dent Educ · Pubmed #26895614.

ABSTRACT: Obstructive sleep apnoea (OSA) is a major health problem which causes blood oxygen desaturation that may initiate a cascade of events via inflammatory cytokines and adrenocorticotrophic hormone that may have impact upon quality of life and lead to potential life-threatening events. Even though OSA affects an increasing number of individuals, the role of dental practitioners in recognition, screening and management has not developed accordingly. The goal of this article was to provide updated information to dental practitioners on pathophysiology, consequences and treatment options of OSA with a focused discussion on oral appliance (OA) therapy, as this topic is not routinely included in current dental curricula of many dental schools. Additionally, we present a template dental curriculum for predoctoral and/or postdoctoral students in education regarding sleep disordered breathing.

22 Article Individual and socio-demographic factors related to presenting problem and diagnostic impressions at a pediatric sleep clinic. 2016

Rubens, Sonia L / Patrick, Kristina E / Williamson, Ariel A / Moore, Melisa / Mindell, Jodi A. ·Psychology Department, University of New Orleans, 2000 Lakeshore Drive, New Orleans, LA 70148, United States. Electronic address: slrubens@uno.edu. · The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104; Drexel University, 3141 Chestnut St, Philadelphia, PA 19104. · The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104; University of Delaware, 209 Laurel Ave, Newark, DE 19711. · The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104. · The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104; Saint Joseph's University, 5600 City Avenue, Philadelphia, PA 19131. ·Sleep Med · Pubmed #27823719.

ABSTRACT: OBJECTIVE: Individual and socio-demographic factors have been found to be associated with sleep disturbances in children. Few studies have examined these factors among children presenting for care at pediatric sleep clinics. This study examined individual and socio-demographic factors in association with presenting problems and diagnostic impressions for new patients at an interdisciplinary pediatric sleep clinic. METHODS: Data were collected from electronic medical records of 207 consecutive patients (54% male, 59% White, Mean RESULTS: Older age, female gender, and White race were associated with higher likelihood of presenting with difficulty falling asleep; younger age, male gender, and Black race were associated with higher likelihood of presenting with obstructive sleep apnea (OSA)-related concerns. Older age was associated with diagnostic impressions of inadequate sleep hygiene, insufficient sleep, circadian rhythm disorder/delayed sleep phase disorder, periodic limb movement disorder/restless legs syndrome, and insomnia, while younger age was associated with provisional OSA and behavioral insomnia of childhood (BIC) diagnoses. Male gender was associated with provisional OSA. White race was associated with BIC. Age-based analyses were also conducted to further understand the findings within a developmental context. CONCLUSIONS: Age- and gender-related findings converged with prevalence literature on pediatric sleep disorders. Race was only associated with presenting concern and BIC, and one association for neighborhood disadvantage was found within the age-based analysis. Results suggest a potential service delivery gap, with racial/ethnic minority youth being less likely to present for sleep services, despite prevalence data on the increased likelihood of sleep disturbances among these youth.

23 Article Can We Assess Pulsus Paradoxus through Polysomnography in a Patient with Chronic Obstructive Pulmonary Disease and Sleep-Disordered Breathing? 2016

Liendo, Cesar / Dalal, Ashtaad / Hinds, Esther / Sara, Samreena / Chernyshev, Oleg / Nutakki, Swathi / de Castro, Jorge Rey / Chesson, Andrew. ·Louisiana State University Health Science Center Sleep Disorders Center, Shreveport, LA. · Overton Brooks VA Medical Center Sleep Disorders Center, Shreveport, LA. · Clinica Anglo Americana, Lima Peru School of Medicine Professor, Universidad Peruana Cayetano Heredia, Lima, Peru. ·J Clin Sleep Med · Pubmed #26951422.

ABSTRACT: ABSTRACT: Pulsus paradoxus (PP) is a decrease in systolic blood pressure greater than 10 mm Hg during inspiration that occurs in various medical conditions. Using polysomnography pulse oximetry signal, photoplethysmography variations of the amplitude of the pulse pressure within the respiratory cycle were observed. There is a proportional relationship between the changes of inspiratory waveform values and the generated PP. A 59-year-old male underwent polysomnography that showed sleep hypoxemia, obstructive sleep-disordered breathing (apnea hypopnea index [AHI] = 5.1and respiratory disturbance index [RDI] = 87.9), with variations of pulse pressure induced primarily by inspiration. The highest variations in the pulse wave were observed in NREM sleep during obstructive respiratory events and in biocalibration during nasal breathing. The lowest variations occurred after the correction of inspiratory obstructive events and during biocalibration when asked to hold his breath.

24 Article Use of modified barium swallow study to measure posterior airway space in obstructive sleep apnea. 2016

Crosby, Tyler / Phillips, Jeff / Carbo, Alberto / Babcock, Kelley / Nathan, Cherie-Ann. ·a Department of Otolaryngology-Head & Neck Surgery , LSUHSC Shreveport , LA , USA ; · b Department of Radiology , LSUHSC Shreveport , LA , USA ; · c Feist-Weiller Cancer Center , LSUHSC Shreveport , LA , USA. ·Acta Otolaryngol · Pubmed #26852777.

ABSTRACT: Conclusion Measurement of the posterior airway space (PAS) using modified barium swallow (MBS) appears to correlate well with CT imaging. This data suggests MBS may be a low-cost alternative imaging modality to assess obstructive sleep apnea patients. Objectives Obstructive sleep apnea research has focused on imaging modalities that supplement polysomnography in evaluation of potential sites of airway obstruction. While several techniques have been used to assess the PAS, many incur significant costs and risks to the patient. This study proposes use of MBS as a simple modality to measure PAS. Advantages include its simplicity, lower radiation, and dynamic tongue base visualization, which may help predict surgical outcomes. It is hypothesized that cephalometric measurements obtained using MBS will correlate well with CT. Methods Thirty-six adult patients who underwent both CT imaging and MBS for head and neck cancer were included. Cephalometric measurements of the PAS were obtained using each imaging modality. Statistical analysis focused on correlating measurements taken using CT and MBS. Results The average PAS measurements were 12.53 ± 1.81 mm and 12.80 ± 1.75 mm by MBS and CT imaging, respectively. In comparing the two modalities, Pearson correlation between CT and MBS measurements revealed significant positive correlations between r = 0.769 and 0.937.

25 Article Childhood obesity patterns and relation to middle-age sleep apnoea risk: the Bogalusa Heart Study. 2016

Bazzano, L A / Hu, T / Bertisch, S M / Yao, L / Harville, E W / Gustat, J / Chen, W / Webber, L S / Shu, T / Redline, S. ·Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA. · Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. · Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA. · Department of Biostatistics and Bioinformatics, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA. · Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. · Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA. ·Pediatr Obes · Pubmed #26780975.

ABSTRACT: BACKGROUND: Obese adults have a higher risk of obstructive sleep apnoea (OSA); however, the relationship between childhood obesity and adult OSA risk is unclear. Objectives This study aimed to examine overweight/obesity (OW) in childhood and risk of OSA in middle age. METHODS: Childhood OW status was classified as never OW, weight cycling, persistent OW and incident OW. After 35 years of follow-up, high risk for OSA was determined by a positive score in ≥2 domains on the Berlin Questionnaire with obesity removed from scoring. RESULTS: At initial assessment, mean (SD) age was 9.9 (2.9) years, and 23.9% were OW. Overall, 25.7% had scores indicating a high risk for OSA. Compared with participants who were never OW, those with persistent OW and incident OW were 1.36 (95%CI: 1.04-1.77) and 1.47 (1.11-1.96) times more likely to be high risk for OSA, after adjustment for multiple risk factors and adult OW status. Participants with an OW duration of 1-4 years, 5-8 years, and 8+ years were 0.96 (0.44-2.09), 1.20 (0.70-2.04) and 1.52 (1.22-1.90) times more likely to be high risk for OSA compared with those who were never OW (P for trend: 0.0002). CONCLUSIONS: These results suggest that childhood OW is associated with a high risk of OSA in middle age.