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Sleep Apnea Syndromes: HELP
Articles from Bethesda
Based on 117 articles published since 2008
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These are the 117 published articles about Sleep Apnea Syndromes that originated from Bethesda during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5
1 Guideline Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities. 2019

Elmets, Craig A / Leonardi, Craig L / Davis, Dawn M R / Gelfand, Joel M / Lichten, Jason / Mehta, Nehal N / Armstrong, April W / Connor, Cody / Cordoro, Kelly M / Elewski, Boni E / Gordon, Kenneth B / Gottlieb, Alice B / Kaplan, Daniel H / Kavanaugh, Arthur / Kivelevitch, Dario / Kiselica, Matthew / Korman, Neil J / Kroshinsky, Daniela / Lebwohl, Mark / Lim, Henry W / Paller, Amy S / Parra, Sylvia L / Pathy, Arun L / Prater, Elizabeth Farley / Rupani, Reena / Siegel, Michael / Stoff, Benjamin / Strober, Bruce E / Wong, Emily B / Wu, Jashin J / Hariharan, Vidhya / Menter, Alan. ·University of Alabama, Birmingham, Alabama. · Central Dermatology, St. Louis, Missouri. · Mayo Clinic, Rochester, Minnesota. · University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. · National Psoriasis Foundation, Portland, Oregon. · National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland. · University of Southern California, Los Angeles, California. · Department of Dermatology, University of California San Francisco School of MedicineSan Francisco, California. · Medical College of Wisconsin, Milwaukee, Wisconsin. · Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York, New York. · University of Pittsburgh, Pennsylvania. · University of California San Diego, San Diego, California. · Baylor Scott and White, Dallas, Texas. · University Hospitals Cleveland Medical Center, Cleveland, Ohio. · Massachusetts General Hospital, Boston, Massachusetts. · Department of Dermatology, Henry Ford Hospital, Detroit, Michigan. · Northwestern University Feinberg School of Medicine, Chicago, Illinois. · Dermatology and Skin Surgery, Sumter, South Carolina. · Colorado Permanente Medical Group, Centennial, Colorado. · University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma. · Icahn School of Medicine at Mount Sinai, New York, New York. · Emory University School of Medicine, Atlanta, Georgia. · University of Connecticut, Farmington, Connecticut; Probity Medical Research, Waterloo, Canada. · San Antonio Uniformed Services Health Education Consortium, Joint-Base San Antonio, Texas. · Dermatology Research and Education Foundation, Irvine, California. · American Academy of Dermatology, Rosemont, Illinois. Electronic address: vhariharan@aad.org. ·J Am Acad Dermatol · Pubmed #30772097.

ABSTRACT: Psoriasis is a chronic, inflammatory, multisystem disease that affects up to 3.2% of the US population. This guideline addresses important clinical questions that arise in psoriasis management and care, providing recommendations on the basis of available evidence.

2 Editorial Missing links. 2015

Randerath, W / Khayat, R / Arzt, M / Javaheri, S. ·Bethanien Hospital, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Aufderhöher Str. 169, 42699 Solingen, Germany. Electronic address: randerath@klinik-bethanien.de. · Sleep Heart Program, The Ohio State University, Columbus, OH, USA. · Department of Internal Medicine II, University Hospital Regensburg, Germany. · Bethesda North Hospital, Professor Emeritus, University of Cincinnati, Cincinnati, Ohio, USA. ·Sleep Med · Pubmed #26611946.

ABSTRACT: -- No abstract --

3 Editorial Should you screen all your sleep apnea patients for thyroid disease? 2015

Holley, Aaron B. ·Walter Reed National Military Medical Center, Bethesda, MD, USA, aholley9@gmail.com. ·Sleep Breath · Pubmed #24840213.

ABSTRACT: -- No abstract --

4 Editorial A role for sleep disorders in pregnancy complications: challenges and opportunities. 2014

Romero, Roberto / Badr, M Safwan. ·Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI. Electronic address: romeror@mail.nih.gov. · Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Wayne State University, Detroit, MI. ·Am J Obstet Gynecol · Pubmed #24359866.

ABSTRACT: -- No abstract --

5 Review Skeletal Surgery for Obstructive Sleep Apnea. 2018

Barrera, José E. ·Department of Surgery, Uniformed Services University, Bethesda, MD, USA; Department of Otolaryngology, University of Texas Health Sciences Center, San Antonio, TX, USA; Texas Facial Plastic Surgery and ENT, 14603 Huebner Road, Building 1, San Antonio, TX 78209, USA. Electronic address: admin@drjosebarrera.com. ·Sleep Med Clin · Pubmed #30396448.

ABSTRACT: Multilevel surgery has been established as the mainstay of treatment for the surgical management of obstructive sleep apnea (OSA). Combined with uvulopalatopharyngoplasty, tongue-base surgeries, including the genioglossus advancement (GA), sliding genioplasty, and hyoid myotomy and suspension, have been developed to target hypopharyngeal obstruction. Total airway surgery consisting of maxillomandibular advancement (MMA) with/without GA has shown significant success. Skeletal procedures for OSA with or without a palatal procedure is a proven technique for relieving airway obstruction during sleep. A case study demonstrating the utility of virtual surgical planning for MMA surgery is presented.

6 Review Tracheostomy for paediatric obstructive sleep apnoea: A systematic review. 2018

Fray, S / Biello, A / Kwan, J / Kram, Y A / Lu, K / Camacho, M. ·School of Medicine,Uniformed Services University of the Health Sciences,Bethesda,Maryland,USA. · Department of Surgery, Division of Otolaryngology,Tripler Army Medical Center,Hawaii,USA. · Department of Surgery, Division of Otolaryngology,San Antonio Military Medical Center,Texas,USA. ·J Laryngol Otol · Pubmed #30073941.

ABSTRACT: OBJECTIVE: To search the international literature (any language) for publications reporting outcomes of tracheostomy performed to treat obstructive sleep apnoea in children. METHOD: Data sources included: Google Scholar, Cumulative Index to Nursing and Allied Health Literature, Embase, Scopus, and PubMed/Medline. Four authors searched systematically through to 20 January 2018. RESULTS: A total of 597 studies were screened; 64 were downloaded and 11 met criteria. A total of 196 patients underwent tracheostomy (mean age, 4.2 years; range, newborn to 18 years); 40 had detailed qualitative data and 6 had detailed quantitative data. Apnoea/hypopnoea index showed a 97 per cent reduction (n = 2) and apnoea index showed a 98 per cent reduction (n = 3). Lowest oxygen saturation showed a 34 oxygen saturation point improvement (n = 3). Several patients demonstrated significant improvement in breathing. All identified patients were syndromic, had significant co-morbidities or had severe obstructive sleep apnoea. CONCLUSION: Based on reports of children who have undergone a tracheostomy, for whom there are pre- and post-operative data, tracheostomy appears to be a successful treatment for obstructive sleep apnoea. However, additional research is recommended given the small number of patients in the literature.

7 Review Effects of Chronic Opioid Use on Sleep and Wake. 2018

Cao, Michelle / Javaheri, Shahrokh. ·Division of Sleep Medicine, Stanford University School of Medicine, 450 Broadway Street, Redwood City, CA 94063, USA. · Bethesda North Hospital, University of Cincinnati College of Medicine, 10535 Montgomery Road, Suite 200, Cincinnati, OH 45242, USA; Division of Pulmonary, Critical Care and Sleep Medicine, The Ohio State University, 181 Taylor Avenue, Columbus, OH 43203, USA. Electronic address: shahrokhjavaheri@icloud.com. ·Sleep Med Clin · Pubmed #29759277.

ABSTRACT: Chronic use of opioids negatively affects sleep on 2 levels: sleep architecture and breathing. Patients suffer from a variety of daytime sequelae. There may be a bidirectional relationship between poor sleep quality, sleep-disordered breathing, and daytime function. Opioids are a potential cause of incident depression. The best therapeutic option is withdrawal of opioids, which proves difficult. Positive airway pressure devices are considered first-line treatment for sleep-related breathing disorders. New generation positive pressure servo ventilators are increasingly popular as a treatment option for opioid-induced sleep-disordered breathing. Treatments to improve sleep quality, sleep-related breathing disorders, and quality of life in patients who use opioids chronically are discussed.

8 Review Neuromuscular function of the soft palate and uvula in snoring and obstructive sleep apnea: A systematic review. 2018

Patel, Jagatkumar A / Ray, Bryan J / Fernandez-Salvador, Camilo / Gouveia, Christopher / Zaghi, Soroush / Camacho, Macario. ·F. Edward Hebert School of Medicine, Uniformed Services University (USU), Bethesda, MD, 20814, USA. Electronic address: jagatkumar.a.patel.mil@mail.mil. · F. Edward Hebert School of Medicine, Uniformed Services University (USU), Bethesda, MD, 20814, USA. · Tripler Army Medical Center, Division of Otolaryngology-Head and Neck Surgery, 1 Jarrett White Rd, Tripler AMC, HI 96859, USA. · Northwestern University, Feinberg School of Medicine, Department of Otolaryngology - Head and Neck Surgery, 676 N. St. Clair, Suite 1325, Chicago, IL 60611, USA. · UCLA Medical Center, Santa Monica, Santa Monica, CA 90404, USA. ·Am J Otolaryngol · Pubmed #29525140.

ABSTRACT: OBJECTIVE: A collapsible upper airway is a common cause of obstructive sleep apnea. The exact pathophysiology leading to a more collapsible airway is not well understood. A progressive neuropathy of the soft palate and pharyngeal dilators may be associated with the progression of snoring to OSA. The purpose of this study is to systematically review the international literature investigating the neurophysiologic changes in the soft palate and uvula that contribute to progression from snoring to OSA. METHODS: PubMed/MEDLINE and 4 other databases were systematically searched through July 4, 2017. Eligibility: (1) Patients: controls, snoring or OSA patients (2) Intervention: neuromuscular evaluation of the palate and/or uvula (3) Comparison: differences between controls, snoring and OSA patients (4) Outcomes: neuromuscular outcomes (5) Study design: Peer reviewed publications of any design. RESULTS: 845 studies were screened, 76 were downloaded in full text form and thirty-one studies met criteria. Histological studies of the soft palate demonstrated diffuse inflammatory changes, muscular changes consistent with neuropathy, and neural aberrancies. Sensory testing studies provided heterogeneous outcomes though the majority favored neuronal dysfunction. Studies have consistently demonstrated that increasing severity of snoring and sleep apnea is associated with worsening sensory nerve function of the palate in association with atrophic histological changes to the nerves and muscle fibers of the soft palate and uvula. CONCLUSIONS: Recent evidence highlighted in this systematic review implicates the role of neurogenic pathology underlying the loss of soft palate and/or uvular tone in the progression of snoring to sleep apnea.

9 Review Mandibular advancement for adult obstructive sleep apnea: A systematic review and meta-analysis. 2017

Noller, Michael W / Guilleminault, Christian / Gouveia, Christopher J / Mack, Douglas / Vivian, Charles / Abdullatif, Jose / Mangili, Stefano / Liu, Stanley Yung / Zaghi, Soroush / Camacho, Macario. ·School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA. Electronic address: mnoller37@gmail.com. · Stanford Hospital and Clinics, Department of Psychiatry, Sleep Medicine Division, 450 Broadway, Redwood City, CA 94063, USA. · Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Stanford Hospital and Clinics, Stanford, CA 95304, USA. · School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA. · Instituto Ferrero de, Neurología y Sueño, División de Cirugía de Sueño, Junín 1120, Buenos Aires, Argentina. · Istituti Ospedalieri Bresciani, S. Anna Hospital, Department of Surgery, ENT, Head and Neck Surgery, Brescia, Lombardy 25100, Italy. · UCLA Medical Center, Santa Monica, Santa Monica, CA 90404, USA. · Tripler Army Medical Center, Division of Otolaryngology, Sleep Surgery, and Sleep Medicine, 1 Jarrett White Rd, Tripler AMC, HI 96859, USA. ·J Craniomaxillofac Surg · Pubmed #29113702.

ABSTRACT: OBJECTIVES: Patients with mandibular insufficiency can be predisposed to obstructive sleep apnea (OSA). The objective of this study was to systematically review the international literature for mandibular advancement surgeries (MAS) as treatment for adult OSA, and then to perform a meta-analysis. METHODS: Four authors searched five databases from the inception of each database through April 5, 2017. The PRISMA statement was followed. RESULTS: 972 studies were screened, 84 were downloaded, and 11 (57 patients) met criteria. In patients with mandibular insufficiency, MAS reduced apnea-hypopnea index (AHI) (50 patients) from 45.9 ± 24.7 to 6.2 ± 10.4 events/h (87% decrease). The lowest oxygen saturation (LSAT) (55 patients) increased from 71.9 ± 14.6% to 89.0 ± 11.0%. The AHI mean difference was -34.8 events/h [95% CI -43.9, -25.8]. The AHI standardized mean difference was -1.8 [95% CI -2.5, -1.2] (indicating a large magnitude of effect). Surgical cure was seen in 75% of those with >16 mm of mandibular advancement vs. 35% of those with <16 mm of advancement [Odds Ratio 5.5; 95% CI 1.06-28.4; Chi Square p = 0.035]. CONCLUSIONS: The current literature supports isolated mandibular advancement as an efficacious treatment modality for adult OSA in select patients with mandibular insufficiency.

10 Review Obesity Hypoventilation Syndrome: Choosing the Appropriate Treatment of a Heterogeneous Disorder. 2017

Piper, Amanda J / BaHammam, Ahmed S / Javaheri, Shahrokh. ·Sleep Unit, Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales 2050, Australia; Central Medical School, University of Sydney, Sydney 2006, New South Wales, Australia. Electronic address: amanda.piper@sydney.edu.au. · The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh 11324, Saudi Arabia; National Plan for Science and Technology, King Saud University, Riyadh 11324, Saudi Arabia. · Montgomery Sleep Laboratory, Bethesda North Hospital, Cincinnati, OH 45242, USA; Pulmonary and Sleep Medicine, University of Cincinnati, Cincinnati, OH, USA; Division of Cardiology, Ohio State University, Columbus, OH, USA. ·Sleep Med Clin · Pubmed #29108613.

ABSTRACT: The obesity hypoventilation syndrome (OHS) is associated with significant morbidity and increased mortality compared with simple obesity and eucapnic obstructive sleep apnea. Accurate diagnosis and commencement of early and appropriate management is fundamental in reducing the significant personal and societal burdens this disorder poses. Sleep disordered breathing is a major contributor to the developmental of sleep and awake hypercapnia, which characterizes OHS, and is effectively addressed through the use of positive airway pressure (PAP) therapy. This article reviews the current evidence supporting different modes of PAP currently used in managing these individuals.

11 Review Positive Airway Pressure Therapy for Hyperventilatory Central Sleep Apnea: Idiopathic, Heart Failure, Cerebrovascular Disease, and High Altitude. 2017

Javaheri, Shahrokh / Brown, Lee K. ·Sleep Laboratory, Bethesda North Hospital, 10535 Montgomery Road, Suite 200, Cincinnati, OH 45242, USA; The University of Cincinnati, Cincinnati, OH, USA; The Ohio University Medical School, Columbus, OH, USA. Electronic address: shahrokhjavaheri@icloud.com. · Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, University of New Mexico Sleep Disorders Center, 1101 Medical Arts Avenue Northeast, Building #2, Albuquerque, NM 87102, USA; Department of Electrical and Computer Engineering, University of New Mexico School of Engineering, University of New Mexico Sleep Disorders Center, 1101 Medical Arts Avenue Northeast, Building #2, Albuquerque, NM 87102, USA. ·Sleep Med Clin · Pubmed #29108611.

ABSTRACT: Central sleep apnea (CSA) and Hunter-Cheyne-Stokes breathing (HCSB) are caused by failure of the pontomedullary pacemaker generating breathing rhythm. CSA/HCSB may complicate several disorders causing recurrent arousals and desaturations. Common causes of CSA in adults are congestive heart failure, stroke, and chronic use of opioids; opioids have hypoventilatory effects. Diagnosis and treatment of hyperventilatory CSA may improve quality of life, and, when associated with heart failure or cerebrovascular disease, reduce morbidity and perhaps mortality.

12 Review Treatment of Obstructive Sleep Apnea: Achieving Adherence to Positive Airway Pressure Treatment and Dealing with Complications. 2017

Lettieri, Christopher J / Williams, Scott G / Collen, Jacob F / Wickwire, Emerson M. ·Department of Pulmonary, Critical Care, and Sleep Medicine, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA. Electronic address: christopher.j.lettieri.mil@mail.mil. · Department of Pulmonary, Critical Care, and Sleep Medicine, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA. · Department of Psychiatry, University of Maryland School of Medicine, 100 North Greene Street, 2nd Floor, Baltimore, MD 21201, USA; Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, 100 North Greene Street, 2nd Floor, Baltimore, MD 21201, USA. ·Sleep Med Clin · Pubmed #29108610.

ABSTRACT: Obstructive sleep apnea is a common and treatable condition, but therapeutic adherence is limited by numerous factors. Despite advances in positive airway pressure (PAP) technology and a multitude of effective pharmacologic and behavioral therapeutic interventions to overcome the most common barriers to PAP, adherence has not increased significantly over the past 30 years. This review aims to identify the most important factors that impact adherence, common barriers to treatment, and evidence-based treatment strategies to maximize the effectiveness of PAP treatment. Complications of PAP treatment and mitigation techniques are also discussed.

13 Review Positive Airway Pressure Device Technology Past and Present: What's in the "Black Box"? 2017

Brown, Lee K / Javaheri, Shahrokh. ·Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, University of New Mexico Sleep Disorders Center, 1101 Medical Arts Avenue NE, Building #2, Albuquerque, NM 87102, USA; Department of Electrical and Computer Engineering, University of New Mexico School of Engineering, University of New Mexico Sleep Disorders Center, 1101 Medical Arts Avenue NE, Building #2, Albuquerque, NM 87102, USA. Electronic address: lkbrown@alum.mit.edu. · Sleep Laboratory, Bethesda North Hospital, 10475 Montgomery Road, Cincinnati, OH 45242, USA; TriHealth Sleep Center, Pulmonary and Sleep Division, Bethesda North Hospital, University of Cincinnati College of Medicine, 10500 Montgomery Road, Cincinnati, OH 45242, USA; The Ohio State University College of Medicine, 473 West 12th Avenue, Columbus, OH 43210, USA. ·Sleep Med Clin · Pubmed #29108606.

ABSTRACT: Since the introduction of continuous positive airway pressure (PAP) for the treatment of obstructive sleep apnea (OSA) in 1981, PAP technology has diversified exponentially. Compact and quiet fixed continuous PAP flow generators, autotitrating PAP devices, and bilevel PAP devices that can treat multiple sleep-disordered breathing phenotypes including OSA, central sleep apnea (CSA), combinations of OSA and CSA, and hypoventilation are available. Adaptive servo-ventilators can suppress Hunter-Cheyne-Stokes breathing and CSA and treat coexisting obstructive events. Volume-assured pressure support PAP apparatus purports to provide a targeted degree of ventilatory assistance while also treating cooccurring OSA and/or CSA.

14 Review Polysomnography results versus clinical factors to predict post-operative respiratory complications following pediatric adenotonsillectomy. 2017

Saur, John S / Brietzke, Scott E. ·Walter Reed National Military Medical Center, USA. · Walter Reed National Military Medical Center, USA; Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, USA. Electronic address: SEBrietzke@msn.com. ·Int J Pediatr Otorhinolaryngol · Pubmed #28583490.

ABSTRACT: OBJECTIVE: Systematically review the published literature comparing the presence of clinical features (age, BMI, co-morbidities, etc.) versus polysomnogram (PSG) results in the prediction of major post-operative respiratory complications following pediatric adenotonsillectomy (T/A) for the treatment of Obstructive Sleep Apnea Syndrome (OSAS). METHODS: A systematic review of the PUBMED and EMBASE databases was performed to identify studies containing both clinical and PSG data predicting major post-operative respiratory complications following T/A. Inclusion criteria included English language and extractable data. Major respiratory complications were defined as events that required significant intervention (intubation, CPAP,etc.) and/or altered patient disposition. Random effect modeling was performed and study quality was assessed using the Newcastle-Ottawa Scale. RESULTS: Twenty-two studies met the inclusion criteria with a median sample size of 157 (range 26-1735) and published between 1992 and 2015. The most common study design was a case series. Most studies included multiple patients at high risk for respiratory complications (Syndromic, obese, etc.). The summary estimate of the major respiratory complication rate following T/A was only 5.8% (95% CI = 4.2-7.4%, p < 0.001, I CONCLUSION: The major respiratory complication rate following pediatric T/A for OSAS is low even amongst series of high risk patients. The majority of the published literature report that readily identified clinical factors predict the large majority of post-operative respiratory complications following T/A.

15 Review Tongue surgeries for pediatric obstructive sleep apnea: a systematic review and meta-analysis. 2017

Camacho, Macario / Noller, Michael W / Zaghi, Soroush / Reckley, Lauren K / Fernandez-Salvador, Camilo / Ho, Erika / Dunn, Brandyn / Chan, Dylan. ·Division of Otolaryngology, Sleep Surgery and Sleep Medicine, Tripler Army Medical Center, Tripler AMC, 1 Jarrett White Rd, Honolulu, HI, 96859, USA. drcamachoent@yahoo.com. · School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA. · Division of Sleep Surgery and Medicine, Department of Otolaryngology-Head and Neck Surgery, Stanford Hospital and Clinics, Stanford, CA, USA. · Division of Otolaryngology and Sleep Medicine, Tripler Army Medical Center, Tripler AMC, Honolulu, HI, USA. · John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, 96813, USA. · University of California Irvine Medical Center, 101 The City Drive South, Orange, CA, 92868, USA. · Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, CA, 94158, USA. ·Eur Arch Otorhinolaryngol · Pubmed #28378061.

ABSTRACT: OBJECTIVES: To evaluate the international literature for studies reporting outcomes for obstructive sleep apnea (OSA) in children undergoing isolated tongue surgeries. METHODS: Two authors searched from inception through November 14, 2016 in four databases including PubMed/MEDLINE. RESULTS: 351 studies were screened. Eleven studies (116 children) met criteria. Most children were syndromic and had craniofacial disorders, co-morbidities, or other serious medical issues. Surgeries included base-of-tongue (BOT) reduction (n = 114), tongue suspension (n = 1), and hypoglossal nerve stimulation (n = 1). The pre- and post-BOT reduction surgeries decreased apnea-hypopnea index (AHI) from a mean (M) and standard deviation (SD) of 16.9 ± 12.2/h to 8.7 ± 10.6/h (48.5% reduction) in 114 patients. Random effects modeling (109 patients) demonstrated a standardized mean difference for AHI of -0.78 (large magnitude of effect) [95% CI -1.06, -0.51], p value <0.00001. For BOT surgery in 53 non-syndromic children, the AHI decreased 59.2% from 14.0 ± 11.4 to 5.7 ± 6.7/h, while in 55 syndromic children, the AHI decreased 40.0% from 20.5 ± 19.1 to 12.3 ± 18.2/h. BOT reduction improved lowest oxygen saturation from M ± SD of 84.7 ± 7.4-87.9 ± 6.5% in 113 patients. Hypoglossal nerve stimulation and tongue-base suspension are limited to case reports. CONCLUSIONS: Most children undergoing tongue surgeries in the literature were syndromic and had craniofacial disorders, co-morbidities, or other serious medical issues. Children with a body mass index <25 kg/m

16 Review Tongue retaining devices for obstructive sleep apnea: A systematic review and meta-analysis. 2017

Chang, Edward T / Fernandez-Salvador, Camilo / Giambo, Jeremy / Nesbitt, Blaine / Liu, Stanley Yung-Chuan / Capasso, Robson / Kushida, Clete A / Camacho, Macario. ·Department of Otolaryngology, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, HI, USA. Electronic address: etchan78@gmail.com. · Department of Otolaryngology, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, HI, USA. Electronic address: cferna25@gmail.com. · Uniformed Services University of the Health Sciences, School of Medicine, Bethesda,MD 20814, USA. Electronic address: jeremy.giambo@usuhs.edu. · Uniformed Services University of the Health Sciences, School of Medicine, Bethesda,MD 20814, USA. Electronic address: nicholas.nesbitt@usuhs.edu. · Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA. Electronic address: stanley.yung.liu@gmail.com. · Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA. Electronic address: rcapasso@stanford.edu. · Department of Psychiatry and Behavioral Sciences, Division of Sleep Medicine,Stanford Hospital and Clinics, 450 Broadway St. 2nd Floor, Redwood City, CA 94063, USA. Electronic address: clete@standford.edu. · Department of Otolaryngology, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, HI, USA; Department of Psychiatry and Behavioral Sciences, Division of Sleep Medicine,Stanford Hospital and Clinics, 450 Broadway St. 2nd Floor, Redwood City, CA 94063, USA. Electronic address: drcamachoent@yahoo.com. ·Am J Otolaryngol · Pubmed #28237516.

ABSTRACT: OBJECTIVE: Tongue Retaining Devices (TRD) anteriorly displace the tongue with suction forces while patients sleep. TRD provide a non-surgical treatment option for patients with Obstructive Sleep Apnea (OSA). Our objective was to conduct a systematic review of the international literature for TRD outcomes as treatment for OSA. METHODS: Three authors independently and systematically searched four databases (including PubMed/MEDLINE) through June 26, 2016. We followed guidelines set within the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). RESULTS: Sixteen studies with 242 patients met criteria. The overall means±standard deviations (M±SD) for apnea-hypopnea index (AHI) decreased from 33.6±21.1/h to 15.8±16.0/h (53% reduction). Seven studies (81 patients) reported lowest oxygen saturation (LSAT), which improved from 79.8±17.5% to 83.9±8.6%. Four studies (93 patients) reported Epworth sleepiness scale (ESS), which decreased from 10.8±4.8 to 8.2±4.5, p <0.0001. Four studies (31 patients) reported Oxygen Desaturation Index (ODI) which decreased from 29.6±32.1 to 12.9±8.7, a 56.4% reduction. CONCLUSION: Current international literature demonstrates that tongue retaining devices reduce apnea-hypopnea index by 53%, increase lowest oxygen saturation by 4.1 oxygen saturation points, decrease oxygen desaturation index by 56% and decrease Epworth sleepiness scale scores by 2.8 points. Tongue retaining devices provide a statistically effective alternative treatment option for obstructive sleep apnea.

17 Review Sleep Apnea: Types, Mechanisms, and Clinical Cardiovascular Consequences. 2017

Javaheri, Shahrokh / Barbe, Ferran / Campos-Rodriguez, Francisco / Dempsey, Jerome A / Khayat, Rami / Javaheri, Sogol / Malhotra, Atul / Martinez-Garcia, Miguel A / Mehra, Reena / Pack, Allan I / Polotsky, Vsevolod Y / Redline, Susan / Somers, Virend K. ·Pulmonary and Sleep Division, Bethesda North Hospital, Cincinnati, Ohio. Electronic address: shahrokhjavaheri@icloud.com. · Respiratory Department, Institut Ricerca Biomèdica de Lleida, Hospital Universitari Arnau de Vilanova, Lleida, Spain. · Respiratory Department, Hospital Universitario de Valme, Sevilla, Spain. · Department of Population Health Sciences and John Rankin Laboratory of Pulmonary Medicine, University of Wisconsin-Madison, Madison, Wisconsin. · Sleep Heart Program, the Ohio State University, Columbus, Ohio. · Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts. · Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego, California. · Respiratory Department, Hospital Universitario de Politecnico La Fe, Valencia, Spain. · Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio. · Division of Sleep Medicine/Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. · Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. · Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts; Beth Israel Deaconess Medical Center, Boston, Massachusetts. · Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota. ·J Am Coll Cardiol · Pubmed #28209226.

ABSTRACT: Sleep apnea is highly prevalent in patients with cardiovascular disease. These disordered breathing events are associated with a profile of perturbations that include intermittent hypoxia, oxidative stress, sympathetic activation, and endothelial dysfunction, all of which are critical mediators of cardiovascular disease. Evidence supports a causal association of sleep apnea with the incidence and morbidity of hypertension, coronary heart disease, arrhythmia, heart failure, and stroke. Several discoveries in the pathogenesis, along with developments in the treatment of sleep apnea, have accumulated in recent years. In this review, we discuss the mechanisms of sleep apnea, the evidence that addresses the links between sleep apnea and cardiovascular disease, and research that has addressed the effect of sleep apnea treatment on cardiovascular disease and clinical endpoints. Finally, we review the recent development in sleep apnea treatment options, with special consideration of treating patients with heart disease. Future directions for selective areas are suggested.

18 Review Laser-Assisted Uvulopalatoplasty for Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis. 2017

Camacho, Macario / Nesbitt, N Blaine / Lambert, Evan / Song, Sungjin A / Chang, Edward T / Liu, Stanley Y / Kushida, Clete A / Zaghi, Soroush. ·Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, Honolulu, HI. · Department of Psychiatry and Behavioral Sciences, Division of Sleep Medicine, Stanford Hospital and Clinics, Redwood City, CA. · F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD. · Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center, Honolulu, HI. · Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Stanford Hospital and Clinics, Stanford, CA. ·Sleep · Pubmed #28201808.

ABSTRACT: Study Objectives: Laser-assisted uvulopalatoplasty (LAUP) has been used as treatment for obstructive sleep apnea (OSA). The objective of this study was to perform a systematic review and meta-analysis for LAUP alone as treatment for OSA in adults. Methods: Three authors searched five databases (including PubMed/MEDLINE) from inception through October 30, 2016 for peer-reviewed studies, with any design/language. A study quality assessment tool was used. The PRISMA statement was followed. A meta-analysis was performed. Results: Twenty-three adult studies (717 patients) reported outcomes (age: 50 ± 9 years, body mass index: 29 ± 4 kg/m2). The pre- and post-LAUP means (M) ± standard deviations (SDs) for apnea-hypopnea index (AHI) were 28 ± 13 and 19 ± 12 events/h (32% reduction). Random effects modeling for 519 patients demonstrated an AHI mean difference (MD) of -6.56 [95% CI -10.14, -2.97] events/h. Individual patient data analyses demonstrate a 23% success rate (≥50% reduction in AHI and <20 events/h) and an 8% cure rate. Additionally, 44% of patients had worsening of their AHI after LAUP. Lowest oxygen saturation (LSAT) improved from a M ± SD of 80 ± 8% to 82 ± 7%. A limitation is that most studies were case series studies and only two were randomized controlled trials. Conclusions: In this meta-analysis, LAUP reduced AHI by 32% among all patients; while the LSAT only changed minimally. Individual data demonstrated a success rate of 23%, cure rate of 8%, and worsening of the AHI among 44% of patients. We recommend that LAUP be performed with caution or not performed at all given the unfavorable results of currently published studies.

19 Review Tongue-lip adhesion and tongue repositioning for obstructive sleep apnoea in Pierre Robin sequence: A systematic review and meta-analysis. 2017

Camacho, M / Noller, M W / Zaghi, S / Reckley, L K / Fernandez-Salvador, C / Ho, E / Dunn, B / Chan, D K. ·Division of Otolaryngology, Sleep Surgery and Sleep Medicine,Tripler Army Medical Center,Honolulu,Hawaii,USA. · School of Medicine,Uniformed Services University of the Health Sciences,Bethesda,Maryland,USA. · Department of Otolaryngology - Head and Neck Surgery,Division of Sleep Surgery and Medicine,Stanford Hospital and Clinics,Redwood City,California,USA. · John A Burns School of Medicine,University of Hawaii,Honolulu,USA. · University of California Irvine Medical Center,San Francisco,Orange. · Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology,University of California,San Francisco,USA. ·J Laryngol Otol · Pubmed #28193305.

ABSTRACT: OBJECTIVE: To search for studies on tongue-lip adhesion and tongue repositioning used as isolated treatments for obstructive sleep apnoea in children with Pierre Robin sequence. METHODS: A systematic literature search of PubMed/Medline and three additional databases, from inception through to 8 July 2016, was performed by two authors. RESULTS: Seven studies with 90 patients (59 tongue-lip adhesion and 31 tongue repositioning patients) met the inclusion criteria. Tongue-lip adhesion reduced the mean (± standard deviation) apnoea/hypopnoea index from 30.8 ± 22.3 to 15.4 ± 18.9 events per hour (50 per cent reduction). The apnoea/hypopnoea index mean difference for tongue-lip adhesion was -15.28 events per hour (95 per cent confidence interval = -30.70 to 0.15; p = 0.05). Tongue-lip adhesion improved the lowest oxygen saturation from 75.8 ± 6.8 to 84.4 ± 7.3 per cent. Tongue repositioning reduced the apnoea/hypopnoea index from 46.5 to 17.4 events per hour (62.6 per cent reduction). Tongue repositioning improved the mean oxygen saturation from 90.8 ± 1.2 to 95.0 ± 0.5 per cent. CONCLUSION: Tongue-lip adhesion and tongue repositioning can improve apnoea/hypopnoea index and oxygenation parameters in children with Pierre Robin sequence and obstructive sleep apnoea.

20 Review Congenital central hypoventilation syndrome: a bedside-to-bench success story for advancing early diagnosis and treatment and improved survival and quality of life. 2017

Weese-Mayer, Debra E / Rand, Casey M / Zhou, Amy / Carroll, Michael S / Hunt, Carl E. ·Center for Autonomic Medicine in Pediatrics (CAMP), Ann & Robert H. Lurie Children's Hospital of Chicago and Stanley Manne Children's Research Institute, Chicago, Illinois. · Feinberg School of Medicine, Northwestern University, Chicago, Illinois. · Pediatrics, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland. · Pediatrics, George Washington University, Washington, D.C. ·Pediatr Res · Pubmed #27673423.

ABSTRACT: The "bedside-to-bench" Congenital Central Hypoventilation Syndrome (CCHS) research journey has led to increased phenotypic-genotypic knowledge regarding autonomic nervous system (ANS) regulation, and improved clinical outcomes. CCHS is a neurocristopathy characterized by hypoventilation and ANS dysregulation. Initially described in 1970, timely diagnosis and treatment remained problematic until the first large cohort report (1992), delineating clinical presentation and treatment options. A central role of ANS dysregulation (2001) emerged, precipitating evaluation of genes critical to ANS development, and subsequent 2003 identification of Paired-Like Homeobox 2B (PHOX2B) as the disease-defining gene for CCHS. This breakthrough engendered clinical genetic testing, making diagnosis exact and early tracheostomy/artificial ventilation feasible. PHOX2B genotype-CCHS phenotype relationships were elucidated, informing early recognition and timely treatment for phenotypic manifestations including Hirschsprung disease, prolonged sinus pauses, and neural crest tumors. Simultaneously, cellular models of CCHS-causing PHOX2B mutations were developed to delineate molecular mechanisms. In addition to new insights regarding genetics and neurobiology of autonomic control overall, new knowledge gained has enabled physicians to anticipate and delineate the full clinical CCHS phenotype and initiate timely effective management. In summary, from an initial guarantee of early mortality or severe neurologic morbidity in survivors, CCHS children can now be diagnosed early and managed effectively, achieving dramatically improved quality of life as adults.

21 Review Transpalatal advancement pharyngoplasty for obstructive sleep apnea: a systematic review and meta-analysis. 2017

Volner, Keith / Dunn, Brandyn / Chang, Edward T / Song, Sungjin A / Liu, Stanley Yung-Chuan / Brietzke, Scott E / O'Connor, Peter / Camacho, Macario. ·Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI, 96859, USA. · John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, 96813, USA. · Division of Sleep Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA. · Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, MD, 20889, USA. · Department of Otolaryngology - Head and Neck Surgery, Sleep Medicine, San Antonio Military Medical Center, Joint Base San Antonio, Fort Sam Houston, TX, 78234, USA. · Division of Sleep Surgery and Medicine, Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI, 96859, USA. drcamachoent@yahoo.com. · Sleep Medicine Division, Department of Psychiatry and Behavioral Sciences, Stanford Hospital and Clinics, Stanford, CA, 95304, USA. drcamachoent@yahoo.com. ·Eur Arch Otorhinolaryngol · Pubmed #27289234.

ABSTRACT: The objective is to determine if apnea-hypopnea index (AHI) and lowest oxygen saturation (LSAT) improve after transpalatal advancement pharyngoplasty (TPAP) with obstructive sleep apnea (OSA) in adults, using a systematic review and meta-analysis. Nine databases, including PubMed/MEDLINE, were searched through April 1, 2016. All studies that included patients who underwent TPAP alone were included in this analysis. Fifty-six studies were potentially relevant, 37 were downloaded and five studies met criteria with 199 patients (age: 42.5 ± 9.7 years and body mass index: 29.0 ± 4.0 kg/m

22 Review Nasal Dilators (Breathe Right Strips and NoZovent) for Snoring and OSA: A Systematic Review and Meta-Analysis. 2016

Camacho, Macario / Malu, Omojo O / Kram, Yoseph A / Nigam, Gaurav / Riaz, Muhammad / Song, Sungjin A / Tolisano, Anthony M / Kushida, Clete A. ·Tripler Army Medical Center, Division of Otolaryngology, Sleep Surgery and Sleep Medicine, 1 Jarrett White Rd, Tripler AMC, Honolulu, HI 96859, USA. · Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA. · Tripler Army Medical Center, Division of Otolaryngology-Head & Neck Surgery, Tripler AMC, Honolulu, HI 96859, USA. · Clay County Hospital, 911 Stacy Burk Drive, Flora, IL 62839, USA. · Sleep Disorders Center, Sunnyside Community Hospital, 1016 Tacoma Avenue, Sunnyside, WA 98944, USA. · Department of Psychiatry and Behavioral Sciences, Sleep Medicine Division, Stanford Hospital and Clinics, Redwood City, CA 94063, USA. ·Pulm Med · Pubmed #28070421.

ABSTRACT:

23 Review Association of allergy/immunology and obstructive sleep apnea. 2016

Calais, Charles J / Robertson, Brian D / Beakes, Douglas E. ·Division of Allergy-Immunology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA. ·Allergy Asthma Proc · Pubmed #27931299.

ABSTRACT: Obstructive sleep apnea (OSA) is characterized by repetitive upper airway collapse that results in nonrefreshing sleep, excessive daytime sleepiness, and, ultimately, adverse consequences on quality of life, the cardiovascular system, and neurocognitive performance. OSA has traditionally been linked to body habitus (obesity and increased neck circumference), racial demographics, alcohol, tobacco, and sedative use. Numerous other conditions are linked to OSA, which may have clinical relevance. Specifically, asthma and nasal obstructive syndromes, e.g., rhinitis, have been shown to be risk factors. This review used the anatomic homogeneity of the upper and lower airways as an explanation for the inflammatory conditions that underlie and interrelate rhinitis, asthma, and OSA. There is strong evidence that both immunoglobulin Emediated and irritant-induced inflammation in either airway location play a significant role in all three (OSA, rhinitis, and asthma). We highlighted pathophysiologic, chemical, and cellular factors that explain the distinct relationship among OSA, asthma, and rhinitis, with emphasis for increased provider vigilance of the other syndromes when a patient is diagnosed with either entity.

24 Review Transoral Robotic Partial Glossectomy and Supraglottoplasty for Obstructive Sleep Apnea. 2016

D'Agostino, Mark A. ·Southern New England Ear, Nose and Throat Group, One Long Wharf Drive Suite 302, New Haven, CT 06511, USA; Section of Otolaryngology, Department of Surgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA; Department of Surgery, Frank H Netter School of Medicine, Quinnipiac University, 370 Bassett Road, North Haven, CT 06473, USA; Department of Surgery, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; Section of Otolaryngology, Department of Surgery, Middlesex Hospital, 28 Crescent Street, Middletown, CT 06457, USA. Electronic address: madago@comcast.net. ·Otolaryngol Clin North Am · Pubmed #27742107.

ABSTRACT: The standard treatment for patients with obstructive sleep apnea syndrome is positive airway pressure (PAP) therapy. However, when PAP therapy fails, surgery may be an option to alleviate the obstruction. The base of tongue plays an important role in this obstruction, and addressing the tongue base surgically can be a challenge for the head and neck surgeon. Transoral robotic surgery (TORS) using the da Vinci Surgical System provides a safe and effective way to approach and manage the base of tongue and supraglottis. Advantages of TORS include wide-field high-definition 3-D visualization, precise instrumentation, and when compared with open procedures, less operative time, quicker recovery, no external scars, and comparable tissue resection.

25 Review Skeletal Surgery for Obstructive Sleep Apnea. 2016

Barrera, José E. ·Department of Surgery, Uniformed Services University, Bethesda, MD, USA; Department of Otolaryngology, University of Texas Health Sciences Center, San Antonio, TX, USA; Texas Facial Plastic Surgery and ENT, 14603 Huebner Road, Building 1, San Antonio, TX 78209, USA. Electronic address: admin@drjosebarrera.com. ·Otolaryngol Clin North Am · Pubmed #27720459.

ABSTRACT: Multilevel surgery has been established as the mainstay of treatment for the surgical management of obstructive sleep apnea (OSA). Combined with uvulopalatopharyngoplasty, tongue-base surgeries, including the genioglossus advancement (GA), sliding genioplasty, and hyoid myotomy and suspension, have been developed to target hypopharyngeal obstruction. Total airway surgery consisting of maxillomandibular advancement (MMA) with/without GA has shown significant success. Skeletal procedures for OSA with or without a palatal procedure is a proven technique for relieving airway obstruction during sleep. A case study demonstrating the utility of virtual surgical planning for MMA surgery is presented.

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