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Sleep Apnea Syndromes: HELP
Articles from Norfolk, VA
Based on 19 articles published since 2008
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These are the 19 published articles about Sleep Apnea Syndromes that originated from Norfolk, VA during 2008-2019.
 
+ Citations + Abstracts
1 Review Mild Obstructive Sleep Apnea in Children: What is the Best Management Option? 2018

Baldassari, Cristina M / Choi, Sukgi. ·Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Children's Hospital of the King's Daughters, Norfolk, Virginia, U.S.A. · Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A. · Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A. ·Laryngoscope · Pubmed #29521427.

ABSTRACT: -- No abstract --

2 Review Systematic Review of Drug-Induced Sleep Endoscopy Scoring Systems. 2018

Amos, Janine M / Durr, Megan L / Nardone, Heather C / Baldassari, Cristina M / Duggins, Angela / Ishman, Stacey L. ·1 Otolaryngology and Facial Plastic Surgery, McLaren Oakland Hospital, Pontiac, Michigan, USA. · 2 Department of Head and Neck Surgery, Kaiser Permanente, Oakland, California, USA. · 3 Division of Otolaryngology, Nemours/AI DuPont Hospital for Children, Wilmington, Delaware, USA. · 4 Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA. · 5 Division of Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. · 6 Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA. · 7 Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. ·Otolaryngol Head Neck Surg · Pubmed #29064308.

ABSTRACT: Objective To systematically review the scoring systems used to report findings during drug-induced sleep endoscopy (DISE) for adults and children with obstructive sleep apnea. Data Sources PubMed, CINAHL, EBM Reviews, Embase, and Scopus databases. Review Methods This is a systematic review of all indexed years of publications referring to scoring of DISE for children and adults with obstructive sleep apnea. The type of DISE scoring system utilized was the primary outcome. PRISMA guidelines were followed to carry out this review; articles were independently reviewed by 2 investigators. All pediatric and adult studies that utilized ≥1 DISE grading systems were included. Results Of 492 identified abstracts, 44 articles (combined population, N = 5784) were ultimately included; 6 reported on children, 35 on adults, and 1 on children and adults. Twenty-one reporting methods were used in these studies, with the most common being the VOTE system (velum, oropharynx, tongue base, and epiglottis; 38.6%) and the Pringle and Croft classification (15.9%). The sites of obstruction most commonly included in a scoring system were the tongue base (62%), lateral pharynx/oropharynx (57%), palate (57%), epiglottis/supraglottis (38%), and hypopharynx (38%). Less commonly included sites were the larynx (29%), velum (23%), nose (23%), tongue (14%), adenoids (10%), and nasopharynx (10%). Conclusion There is no consensus regarding which scoring system should be utilized to report findings during DISE. The VOTE system and the Pringle and Croft classification were the most frequent scoring systems reported for patients undergoing DISE. Standardization of the reporting of DISE findings would improve comparability among studies.

3 Review Tonsillectomy for adult obstructive sleep apnea: A systematic review and meta-analysis. 2016

Camacho, Macario / Li, Dongcai / Kawai, Makoto / Zaghi, Soroush / Teixeira, Jeffrey / Senchak, Andrew J / Brietzke, Scott E / Frasier, Samuel / Certal, Victor. ·Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, Honolulu, Hawaii. · Department of Psychiatry and Behavioral Sciences, Sleep Medicine Division, Stanford Hospital and Clinics, Stanford, California. · Shenzhen Key Laboratory of ENT, Institute of ENT & Longgang ENT hospital, Shenzhen, China, Stanford, California. · Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, Stanford, California. · Sierra Pacific Mental Illness Research Education and Clinical Centers, VA Palo Alto Health Care System, Palo Alto, California. · Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California. · Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland. · Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA. · Department of Otorhinolaryngology/Sleep Medicine Centre-Hospital CUF & CHEDV Porto, University of Porto, Porto, Portugal. · CINTESIS-Center for Research in Health Technologies and Information Systems, University of Porto, Porto, Portugal. ·Laryngoscope · Pubmed #27005314.

ABSTRACT: OBJECTIVES/HYPOTHESIS: To determine if sleepiness and sleep study variables (e.g., Apnea-Hypopnea Index [AHI] and lowest oxygen saturation) improve following isolated tonsillectomy for adult obstructive sleep apnea (OSA). STUDY DESIGN: Systematic review and meta-analysis. METHODS: Nine databases (PubMed/MEDLINE included) were searched through November 24, 2015. RESULTS: Seventeen studies (n = 216 patients, 34.4 ± 10.0 years and body mass index: 29.0 ± 6.1 kg/m(2) ) met criteria. Tonsils sizes were hypertrophied, large, enlarged, extremely enlarged, or grades 2 to 4. Apnea-Hypopnea Index decreased by 65.2% (from 40.5 ± 28.9/hour to 14.1 ± 17.1/hour) (n = 203). The AHI mean difference (MD) was -30.2 per hour (95% confidence interval [CI] -39.3, -21.1) (P value < 0.00001). The AHI SMD was -1.37 (-1.65, -1.09) (large effect). Lowest oxygen saturation improved from 77.7 ± 11.9% to 85.5 ± 8.2% (n = 186). Lowest oxygen saturation MD was 8.5% (95% CI 5.2, 11.8) (P value < 0.00001). The Epworth Sleepiness Scale decreased from 11.6 ± 3.7 to 6.1 ± 3.9 (P value < 0.00001) (n = 125). Individual patient outcomes (n = 54) demonstrated an 85.2% success rate (AHI < 20/hour and ≥ 50% reduction) and a 57.4% cure rate. Individual patient data meta-analysis showed preoperative AHI < 30 per hour to be a significant predictor of surgical success (P value < 0.001) and cure (P value = 0.043); among patients with preoperative AHI < 30 per hour, tonsillectomy success rate was 100% (25 of 25) and cure rate was 84% (21 of 25) with a mean postoperative AHI of 2.4 ± 2.1 per hour; this compares to tonsillectomy success rate of 72.4% (21 of 29), cure rate of 10 of 29 (34.4%), and mean postoperative AHI of 14.3 ± 13.9 per hour for patients with preoperative AHI ≥ 30 per hour. CONCLUSION: Isolated tonsillectomy can be successful as treatment for adult OSA, especially among patients with large tonsils and mild to moderate OSA (AHI < 30/hour). Laryngoscope, 2016 Laryngoscope, 126:2176-2186, 2016.

4 Article Adenotonsillectomy outcomes in children with sleep apnea and narcolepsy. 2017

Biyani, Sneh / Cunningham, Tina D / Baldassari, Cristina M. ·Department of Otolaryngology - Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, USA. Electronic address: biyanis@evms.edu. · Graduate Program in Public Health, Eastern Virginia Medical School, Norfolk, VA, USA. · Department of Otolaryngology - Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, USA; Department of Pediatric Otolaryngology, Children's Hospital of The King's Daughters, Norfolk, VA, USA. ·Int J Pediatr Otorhinolaryngol · Pubmed #28802388.

ABSTRACT: OBJECTIVE: To identify improvements in daytime sleepiness following adenotonsillectomy in children with non-severe obstructive sleep apnea and narcolepsy. STUDY DESIGN: Case series with chart review over 15 years. SETTING: Tertiary Children's Hospital. SUBJECTS AND METHODS: Children between 6 and 17 years of age with narcolepsy that underwent adenotonsillectomy for non-severe obstructive sleep apnea (OSA) were included. Narcolepsy was diagnosed based on clinical assessment and the Multiple Sleep Latency Test (MSLT) results. A standardized instrument, the pediatric Epworth Sleepiness Scale (ESS), was used to assess daytime sleepiness before and after adenotonsillectomy. RESULTS: Nine children with a mean age of 12.1 years were included. The majority of the subjects (78%, n = 7) were African American and six children (66.7%) were obese. Four children (44%) were treated with wake promoting agents during the study. The mean preoperative apnea hypopnea index on polysomnography was 4.89 (SD 1.86), while the mean sleep latency on MSLT was 6.32 min (SD 3.14). The mean preoperative ESS was 16.10 and the postoperative ESS was 10.80 (SD 3.96). There was significant improvement (p = 0.02) in the ESS following adenotonsillectomy with seven children (78%) reporting diminished daytime sleepiness. CONCLUSIONS: Children with non-severe OSA and narcolepsy experience significant improvement in daytime sleepiness following adenotonsillectomy. Future studies are needed to determine the incidence and clinical significance of non-severe OSA in children with narcolepsy.

5 Article The deterioration of driving performance over time in drivers with untreated sleep apnea. 2016

May, Jennifer F / Porter, Bryan E / Ware, J Catesby. ·Old Dominion University, Department of Psychology, Norfolk, VA, United States; Sentara Healthcare, Sleep Centers, Norfolk, VA, United States. Electronic address: jlfreema@sentara.com. · Old Dominion University, Department of Psychology, Norfolk, VA, United States. · Eastern Virginia Medical School, Division of Sleep Medicine, Norfolk, VA, United States. ·Accid Anal Prev · Pubmed #26851617.

ABSTRACT: Sleep apnea increases risk of driving crashes when left untreated. This study examined the driving performance decrements of untreated, undiagnosed sleep apnea drivers compared with healthy controls in a monotonous highway driving simulator task. It was hypothesized that the sleep apnea group would perform worse during a driving simulator test compared with the control group. A significant group by time interaction occurred indicating that sleep apnea participants' performance degraded more quickly over the course of the drive. In contrast with previous studies, this sleep apnea group did not include sleep disorder center patients, but rather community volunteers whose screening indicated a significant apnea/hypopnea index of 15 or greater. There may be inherent differences between patients and nonpatients with sleep apnea, as patients may have a more significant impact on their quality of life, causing them to seek treatment. Still, the results are clear that although the sleep apnea group drove similarly to the control group at the start of the drive, they are sensitive to time on task effects. These results support the need to diagnose and treat sleep apnea.

6 Article Is MRI Necessary in the Evaluation of Pediatric Central Sleep Apnea? 2015

Woughter, Meghan / Perkins, Amy M / Baldassari, Cristina M. ·Eastern Virginia Medical School, Norfolk, Virginia, USA. · Department of Pediatrics, Division of Biostatistics and Innovation in Research Design, Children's Hospital of The King's Daughters, Eastern Virginia Medical School, Norfolk, Virginia, USA. · Department of Otolaryngology, Eastern Virginia Medical School, Children's Hospital of The King's Daughters, Norfolk, Virginia, USA baldassc@gmail.com cristina.baldassari@chkd.org. ·Otolaryngol Head Neck Surg · Pubmed #26227470.

ABSTRACT: OBJECTIVES: (1) To determine the prevalence of central nervous system (CNS) pathology identified on head magnetic resonance imaging (MRI) scans in children with central sleep apnea (CSA); (2) to assess the yield of MRI in evaluation of CSA; and (3) to identify factors that predict CNS pathology in children with CSA. STUDY DESIGN: Case series with chart review. SETTING: Tertiary children's hospital. SUBJECTS AND METHODS: A chart review was conducted over 12 years. Patients 6 months to 18 years of age who underwent head MRI for evaluation of CSA were included. CSA was diagnosed on polysomnogram as central apnea index >1. RESULTS: Forty children were included in the CSA group. Twenty-two patients were male, and the mean age was 60 ± 41.5 months. The mean central apnea index was 3.8 ± 1.9, while the mean obstructive apnea hypopnea index was 3.4 (interquartile range, 0.7-3.8). Eighteen percent (7 of 40) of children with CSA had evidence of CNS pathology on MRI, with the most common finding (n = 3) being arachnoid cyst. Children with CSA who had gastroesophageal reflux disease or abnormal neurologic examinations were more likely to have CNS pathology. Other factors, such as prematurity, did not improve the yield of MRI in children with CSA. CONCLUSIONS: While routine evaluation of children with elevated central apnea index by MRI is not indicated, providers should consider neuroimaging in children with CSA and abnormal neurologic examination findings or gastroesophageal reflux disease. Further research is necessary to identify other tests with improved diagnostic yield for evaluation of pediatric CSA.

7 Article A 44-year-old woman with excessive sleepiness. Opioid-induced central sleep apnea. 2014

Tovar-Torres, María Paula / Bodkin, Cynthia / Sigua, Ninotchka L. ·Department of Medicine, Eastern Virginia Medical School, Norfolk, VA. · Department of Neurology, Indiana University School of Medicine, Indianapolis, IN. · Department of Medicine, Division of Pulmonary, Allergy, Critical Care, Occupational and Sleep Medicine, Indiana University School of Medicine, Indianapolis, IN. Electronic address: nsigua@iu.edu. ·Chest · Pubmed #25451363.

ABSTRACT: -- No abstract --

8 Article Polysomnographic results of prone versus supine positioning in micrognathia. 2014

Kimple, Adam J / Baldassari, Cristina M / Cohen, Aliza P / Landry, April / Ishman, Stacey L. ·Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, NC, United States. · Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, United States; Department of Pediatric Otolaryngology, Children's Hospital of The King's Daughters, Norfolk, VA, United States. · Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States. · Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Division of Pediatric Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, United States. Electronic address: stacey.ishman@cchmc.org. ·Int J Pediatr Otorhinolaryngol · Pubmed #25282304.

ABSTRACT: BACKGROUND: Children with micrognathia commonly present with upper airway symptoms and are at risk for developing obstructive sleep apnea (OSA). Prone positioning is widely used as first-line management for micrognathic children with obstructive symptoms. The aim of the present study was to document the effect of positioning on oxygenation and upper airway obstruction as measured by polysomnography (PSG). METHODS: Three children with micrognathia from two institutions underwent PSG in both the prone and supine position. RESULTS: Patient ages were 1 week, 3 months, and 7 months. Supine obstructive apnea-hypopnea indices (oAHI) were severe for all 3 children, with a mean of 21.9 events/hour (range 16.8 to 26.3). In the prone position, the oAHI significantly improved in 2 of 3 children, with a mean of 5.1 events/hour (range 0.3 to 10.3). The frequency of central apnea events increased in 1 child following supine positioning. Nadir oxygen saturation improved in 2 of 3 children and remained within normal limits in the third. CONCLUSIONS: This is the first report of the effect of positioning on changes in PSG indices of micrognathic children. Improvement in obstructive PSG indices occurred with prone positioning, though OSA persisted in 2 of 3 children. The effect of positioning on central apnea was unclear. In light of these findings, we recommend that routine PSG be considered in micrognathic children undergoing prone positioning for definitive therapy of upper airway obstruction.

9 Article Correlation between REM AHI and quality-of-life scores in children with sleep-disordered breathing. 2014

Baldassari, Cristina Marie / Alam, Lyla / Vigilar, Maria / Benke, James / Martin, Charley / Ishman, Stacey. ·Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, and Department of Pediatric Otolaryngology, Children's Hospital of the King's Daughters, Norfolk, Virginia, USA cristina.baldassari@chkd.org baldassc@gmail.com. · Eastern Virginia Medical School, Norfolk, Virginia, USA. · Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. · Eastern Virginia Medical School, Graduate Program in Public Health, Norfolk, Virginia, USA. · Departments of Pediatric Otolaryngology-Head & Neck Surgery & Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, and Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA. ·Otolaryngol Head Neck Surg · Pubmed #25164468.

ABSTRACT: OBJECTIVES: Prior research has demonstrated poor correlation between the obstructive apnea-hypopnea index (AHI) on full-night polysomnogram (PSG) and quality-of-life (QOL) scores. We aim to examine the association between rapid eye movement (REM) AHI and QOL scores in children with sleep-disordered breathing (SDB). STUDY DESIGN: Prospective trial. SETTING: Two tertiary children's hospitals. SUBJECTS AND METHODS: Children between 3 and 16 years of age with suspected SDB who were undergoing PSG were eligible. Children with craniofacial anomalies were excluded. Subjects' caregivers completed the Obstructive Sleep Apnea-18 (OSA-18), a validated QOL survey. Power analysis determined a group size of 34. RESULTS: One hundred twenty-seven patients were enrolled. The mean (SD) age was 6.3 (3.3) years. Most subjects (52%) were black and 26% were obese. The mean (SD) obstructive AHI of the subject population was 5.4 (11.9), while the mean (SD) REM AHI was 13.1 (23.7). The mean total OSA-18 score was 65.2, indicating a moderate impact of SDB on QOL. Neither the obstructive AHI (P = .73) nor the REM AHI (P = .49) correlated with total OSA-18 scores. However, lower nadir oxygen saturation was associated with significantly poorer QOL (P = .02). The sleep disturbance OSA-18 subset score significantly correlated with both the obstructive AHI (r (2) = 0.22; P = .01) and the REM AHI (r (2) = 0.22; P = .01); the remaining 4 subset scores did not correlate with either factor. CONCLUSION: Neither obstructive AHI nor REM AHI correlates with total OSA-18 QOL scores. With the exception of nadir oxygen saturation, PSG parameters do not reflect the burden of SDB on QOL in children.

10 Article Is cardiology evaluation necessary in children with electrocardiogram abnormalities noted on polysomnogram? 2014

Baldassari, Cristina M / Beydoun, Hind A / Peak, Jessica / Reed, John H. ·Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA. ·Otolaryngol Head Neck Surg · Pubmed #24493790.

ABSTRACT: OBJECTIVES: (1) To determine the prevalence of cardiac disease in children with electrocardiogram (ECG) abnormalities on polysomnogram (PSG). (2) To assess whether factors such as family history of heart disease and severity of sleep apnea are associated with cardiac disease. STUDY DESIGN: Case series with chart review from 2002 to 2012. SETTING: Tertiary children's hospital. SUBJECTS AND METHODS: Children between 1 and 16 years of age with ECG abnormalities on PSG who were referred to cardiology for evaluation were included. Children with a known history of cardiac disease were excluded. RESULTS: Sixty-one children had ECG abnormalities on PSG and were subsequently referred to cardiology. The mean age was 6.5 years (SD, 4.5), and 64% (n = 39) of subjects were African American. The mean obstructive apnea hypopnea index (AHI) was 8.8 (SD, 13.3), and 26% of the children had severe obstructive sleep apnea (AHI >10). The most common ECG abnormality (n = 52) recorded on PSG was premature ventricular contractions. Thirty percent (n = 18) of children had marked arrhythmias noted on their PSG ECG. Most children referred to cardiology underwent echocardiogram (45/61) and 24-hour arrhythmia monitoring (42/61). Five children (8%) had cardiac pathology, including atrial and ventricular ectopy, tuberous sclerosis, mitral regurgitation, and aortic insufficiency. Factors such as family history of heart disease (P = .40) and severe OSA (P = .74) were not associated with cardiac pathology. CONCLUSION: Cardiac pathology in children with abnormal ECGs on PSG is common. Cardiology referral in such patients should be considered. Further research is needed to determine the appropriate cardiac workup.

11 Article Adenotonsillectomy vs observation for management of mild obstructive sleep apnea in children. 2014

Volsky, Peter G / Woughter, Meghan A / Beydoun, Hind A / Derkay, Craig S / Baldassari, Cristina M. ·Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA. ·Otolaryngol Head Neck Surg · Pubmed #24170659.

ABSTRACT: OBJECTIVE: To determine the impact of adenotonsillectomy vs observation on quality of life (QOL) in children with mild obstructive sleep apnea (OSA). STUDY DESIGN: Prospective, nonrandomized trial. SETTING: Tertiary children's hospital. SUBJECTS AND METHODS: Sixty-four children (ages 3-16 years) with mild OSA (apnea hypopnea index between 1 and 5 on polysomnogram) completed the study. Caregivers chose between management options of adenotonsillectomy and observation and completed validated QOL instruments (OSA-18 and Children's Health Questionnaire) at baseline, early, and late follow-ups. The primary outcome measure was QOL. RESULTS: Thirty patients chose adenotonsillectomy, while 34 were observed. Total OSA-18 scores at baseline were significantly poorer (P = .01) in the surgery group (72.3) compared with the observation group (58.5). Four months following surgery, OSA-18 scores improved by 39.1 points over baseline (P = .0001), while there was no change for the observation group (P = .69). After 8 months, OSA-18 scores remained improved in the surgery group, and observation group scores improved by 13.4 points over baseline (P = .005). While OSA-18 scores at the late follow-up visit were poorer in the observation group, the difference was not statistically significant (P = .05). Six observation patients opted for adenotonsillectomy during the study. CONCLUSION: Quality of life significantly improves in children with mild OSA after adenotonsillectomy. In children with mild OSA who are observed, QOL improvements at early follow-up are less pronounced, but significant improvements in QOL are evident after 8 months. QOL instruments may be useful tools to help providers determine which children with mild OSA may benefit from early intervention.

12 Article The otolaryngologic manifestations of Sotos syndrome. 2013

Gaudreau, Philip / Zizak, Vincent / Gallagher, Thomas Q. ·Naval Medical Center, Portsmouth, VA, United States. Electronic address: pgaudreau164@gmail.com. ·Int J Pediatr Otorhinolaryngol · Pubmed #24060089.

ABSTRACT: OBJECTIVE: Soto's syndrome is a genetic disorder caused by mutations in the NSD1 gene. It is characterized by excessive growth in early life. It features craniofacial abnormalities, developmental delay, hypotonia and advanced bone age. A review of the current literature reveals only chronic otitis media and conductive hearing loss as otolaryngologic manifestations of Soto's syndrome. Our objective was to determine if there are additional manifestations relevant to the otolaryngologist. METHODS: We performed a retrospective case series in which the Department of Defense electronic medical record was searched for ICD 9 code 253.0 (acromegaly/gigantism). Records were reviewed for genetic testing indicative of Soto's syndrome. These records were further analyzed for evidence of otolaryngologic problems. RESULTS: Seventeen patients were identified with five having confirmed NSD1 mutations consistent with Soto's syndrome. Of these, 4/5 had otolaryngologic problems such as conductive hearing loss, aspiration, laryngomalacia, obstructive sleep apnea and sensorineural hearing loss. CONCLUSIONS: Currently there is no description in the literature of these additional manifestations of Soto's syndrome. We present this case series to support the idea that an otolaryngologist should be involved in the multidisciplinary care required for these patients.

13 Article Nocturnal diaphoresis secondary to mild obstructive sleep apnea in a patient with a history of two malignancies. 2013

Vorona, Robert Daniel / Szklo-Coxe, Mariana / Fleming, Mark / Ware, J Catesby. ·Division of Sleep Medicine, Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA 23510, USA. voronard@evms.edu ·J Clin Sleep Med · Pubmed #23853568.

ABSTRACT: Numerous medical disorders, including obstructive sleep apnea, may cause nocturnal diaphoresis. Previous work has associated severe obstructive sleep apnea with nocturnal diaphoresis. This case report is of import as our patient with severe nocturnal diaphoresis manifested only mild sleep apnea, and, for years, his nocturnal diaphoresis was ascribed to other causes, i.e., first prostate cancer and then follicular B-cell lymphoma. Additionally, it was the nocturnal diaphoresis and not more common symptoms of obstructive sleep apnea, such as snoring, that led to the definitive diagnosis of his sleep apnea and then to treatment with a gratifying resolution of his onerous symptom.

14 Article Characteristics of patients with the "malignant obesity hypoventilation syndrome" admitted to an ICU. 2013

Marik, Paul E / Desai, Himanshu. ·Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA 23507, USA. marikpe@evms.edu ·J Intensive Care Med · Pubmed #22564878.

ABSTRACT: BACKGROUND: The incidence of obesity in westernized nations is increasing at an alarming rate. We have noted an increasing number of patients admitted to our intensive care unit (ICU) with hypercapnic respiratory failure and multisystem organ dysfunction related to obesity. We have coined the term the malignant obesity hypoventilation syndrome (MOHS) to describe this entity. METHODS: We reviewed the hospital records of all patients who were admitted to our ICU over an 8-month period, with a body mass index (BMI) greater than 40 kg/m² and a PaCO₂ greater than 45 mm Hg. We excluded patients with musculoskeletal disease, intrinsic lung disease, and those with >20 pack-year smoking history. RESULTS: Sixty-one patients (8% of all admissions) met the inclusion criteria for our study. The patients' mean BMI was 48.9 ± 8.6 kg/m². The patients' mean age was 59 ± 11; 47 (77%) were female and 56 (92%) were black. All patients were admitted to the ICU with hypercapnic respiratory failure. The patients had been admitted to our hospital on average 6 times over the previous 2 years; 75% had been erroneously diagnosed and treated for chronic obstructive pulmonary disease (COPD)/asthma and 86% had been treated with diuretics for congestive cardiac failure. All patients had type 2 diabetes and the metabolic syndrome. Three patients had a tracheotomy in place at admission and required mechanical ventilation. All of the remaining patients were treated with noninvasive bilevel positive airway pressure (BiPAP), with 23 patients failing BiPAP and requiring mechanical ventilation. Seven patients had a tracheotomy performed. On the basis of unexplained abnormalities of liver function tests, 39 patients (64%) were presumptively diagnosed with nonalcoholic steatohepatitis (NASH). Pulmonary function tests were suggestive of a restrictive pattern in all patients tested. By echocardiography 43 (71%) patients had left ventricular hypertrophy and 37 (61%) patients had features of left ventricular diastolic dysfunction. Forty-seven (77%) patients had pulmonary hypertension, which was moderate to severe (pulmonary systolic pressure >45 mm Hg) in 25 cases. All patients had an elevated C-reactive protein (9.4 ± 6.9 mg/dL), and all but 1 were vitamin D deficient (13.5 ± 8.5 ng/mL). Eleven patients (18%) died during the index hospitalization. CONCLUSIONS: MOHS is a serious multisystem disorder with a high mortality that appears to be relatively common, frequently misdiagnosed, and inadequately treated.

15 Article Changes in central apnea index following pediatric adenotonsillectomy. 2012

Baldassari, Cristina M / Kepchar, Jessica / Bryant, Lucas / Beydoun, Hind / Choi, Sukgi. ·Department of Otolaryngology--Head and Neck Surgery, Eastern Virginia Medical School, Children's Hospital of the King's Daughters, Norfolk, Virginia 23507, USA. cristina.baldassari@chkd.org ·Otolaryngol Head Neck Surg · Pubmed #22075072.

ABSTRACT: OBJECTIVES: To determine if there are changes in the central apnea index (CAI) when pediatric patients undergo adenotonsillectomy for obstructive sleep apnea (OSA). STUDY DESIGN: Case series with chart review. SETTING: Two tertiary children's hospitals. SUBJECTS AND METHODS: Children between 1 and 16 years of age who underwent adenotonsillectomy for OSA and had both preoperative and postoperative full-night polysomnography (PSG) with CAI greater than 1 on preoperative PSG were eligible for inclusion. Central apnea was defined as the absence of both inspiratory effort and chest wall movement lasting longer than 20 seconds. Criteria for diagnosis of central sleep apnea (CSA) was CAI greater than 1. RESULTS: A total of 101 children with OSA had preoperative and postoperative PSG. Fifteen of these patients had a preoperative CAI greater than 1. The mean age was 67.7 months (SD, 62.7 months). The CAI ranged from 1.1 to 11.1. The mean preoperative CAI was 3.9 (SD, 2.9), while the mean postoperative CAI was 1.9 (SD, 4.8). There was significant improvement (P = .008) of the CAI following adenotonsillectomy. Ninety percent of subjects with mild CSA (CAI between 1 and 5) had postoperative resolution of their disease. There was also significant improvement (P = .004) in the obstructive apnea hypopnea index (AHI), with the mean preoperative AHI of 22.8 (SD, 19.8) decreasing to an AHI of 5.5 (SD, 6.5) postoperatively. CONCLUSIONS: Children with OSA and mild CSA on preoperative PSG showed significant improvement in CAI following adenotonsillectomy. Future studies are needed to determine the clinical significance of CSA in children with OSA and to identify treatment strategies.

16 Article Obstructive sleep disorders in Prader-Willi syndrome: The role of surgery and growth hormone. 2010

DeMarcantonio, Michael A / Darrow, David H / Gyuricsko, Eric / Derkay, Craig S. ·Eastern Virginia Medical School, Norfolk, VA, USA. ·Int J Pediatr Otorhinolaryngol · Pubmed #20880597.

ABSTRACT: OBJECTIVE: To review the effectiveness and safety of surgical intervention for obstructive sleep apnea in Prader-Willi syndrome. BACKGROUND: The muscle hypotonia and obesity associated with Prader-Willi syndrome (PWS) result in a high rate of obstructive sleep apnea (OSA). The use of growth hormone therapy in these patients has been associated with sudden death, raising concerns that such treatment may exacerbate obstructive sleep apnea. As a result, it has been suggested that children with PWS be evaluated for OSA and indications for adenotonsillectomy prior to instituting growth hormone therapy. The true effectiveness of surgical intervention in these cases, however, remains in doubt. METHODS: Retrospective review of patients with a diagnosis of PWS who underwent adenoidectomy or adenotonsillectomy from January 2001 to July 2009 at a regional, tertiary care children's hospital. Patients underwent pre-operative and post-operative polysomnography. Differences between pre-operative and post-operative body-mass index (BMI), apnea-hypopnea index (AHI), and median oxygen saturation and oxygen saturation nadir were analyzed. RESULTS: Five patients were identified during the study period. Three patients underwent adenotonsillectomy, 1 patient adenoidectomy alone, and another adenotonsillectomy with uvulopalatopharyngoplasty (UPPP). While median AHI was found to have decreased from 16.4 to 4.4, no statistically significant change could be demonstrated (p=0.274). Mean O(2) and nadir O(2) saturation also improved, but without reaching statistical significance. No intra-operative complications were noted. CONCLUSIONS: Our series, and other small case series, have demonstrated that complete resolution of sleep apnea in PWS patients is difficult to obtain with upper airway surgery alone. It is suggested that children with PWS being considered for growth hormone therapy undergo assessment for OSA by polysomnography. Patients identified with OSA should be referred for management by tonsillectomy and/or continuous positive airway pressure (CPAP) and then reassessed for residual airway obstruction prior to instituting hormonal therapy.

17 Minor In Reply: Opioid therapy and sleep apnea. 2017

Galicia-Castillo, Marissa C. ·Eastern Virginia Medical School, Norfolk, VA, USA. ·Cleve Clin J Med · Pubmed #28198693.

ABSTRACT: -- No abstract --

18 Minor Use of a chinstrap in treating sleep disordered breathing and snoring. 2014

Vorona, Robert Daniel / Ware, J Catesby. ·Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA. ·J Clin Sleep Med · Pubmed #25348246.

ABSTRACT: -- No abstract --

19 Retraction The malignant obesity hypoventilation syndrome (MOHS). 2012

Marik, P E. ·Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA 23507, USA. marikpe@evms.edu ·Obes Rev · Pubmed #22708580.

ABSTRACT: We have coined the term 'malignant obesity hypoventilation syndrome' (MOHS) to describe a severe multisystem disease due to the systemic effects of obesity. Patients with this syndrome have severe obesity-related hypoventilation together with systemic hypertension, diabetes and the metabolic syndrome, left ventricular hypertrophy with diastolic dysfunction, pulmonary hypertension and hepatic dysfunction. This syndrome is largely unrecognized as physicians do not make the association between the patients' multiple medical problems and obesity. Because of the delayed diagnosis and progressive morbidities of this condition, all patients with a body mass index of more than 40 kg m(-2) should be screened for MOHS. The management of patients with MOHS includes short-term measures to improve the patients' medical condition and long-term measures to achieve enduring weight loss. Bariatric surgery reverses or improves the multiple metabolic and organ dysfunctions associated with MOHS and should be strongly considered in these patients.