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Obstructive sleep disordered breathing in children – an important problem in the light of current European guidelines

100%
Krzeski A., Burghard M.
Polish Journal of Otolaryngology
|
2018
|
vol. 72
|
issue 5
9-16
EN
Obstructive sleep disordered breathing (SDB) is a common clinical problem. An unrecognized and untreated SDB is a serious threat for an intensively developing organism of a child. The consequences of SDB include cardiovascular and neurological complications, growth disorders and enuresis. Therefore, SDB in children becomes an important subject of many scientific investigations, publications and congresses. In 2015 the European Respiratory Society Task Force published a document concerning the conclusions about the diagnostics and treatment of SDB in children and youth from 2 to 18 years of age (Fig. 1). The scientific data from 362 publications were presented in a condensed form of “seven steps”, very useful in diagnosing and treatment planning (1). The authors underline the limited number of the reliable evidence about SDB: prospective studies, randomized double-blinded studies with placebo. The presented evidence was categorized depending on their quality according to the classification of the American Academy of Neurology (ANN) into classes I – IV. Previously, in 2012, the guidelines of the American Academy of Pediatrics on obstructive sleep apnea syndrome (OSAS) in children with tonsillar hypertrophy and/or obesity were published (2, 3) and they were a valuable diagnostic and therapeutic compendium. The European guidelines discussed in this article result from the progress of knowledge in the recent years, they cover the subject broadly, consider rare and difficult cases and present the spectrum of potential therapeutic actions. The aim of the guidelines is a better recognition of SDB, a systematization of diagnosis and treatment at every stage of medical care, including the causes of this disorder and its complications.
2
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Obstructive sleep disordered breathing in children – an important problem in the light of current European guidelines

100%
Krzeski A., Burghard M.
Otolaryngologia Polska
|
2018
|
vol. 72(5)
9-16
EN
Obstructive sleep disordered breathing (SDB) is a common clinical problem. An unrecognized and untreated SDB is a serious threat for an intensively developing organism of a child. The consequences of SDB include cardiovascular and neurological complications, growth disorders and enuresis. Therefore, SDB in children becomes an important subject of many scientific investigations, publications and congresses. In 2015 the European Respiratory Society Task Force published a document concerning the conclusions about the diagnostics and treatment of SDB in children and youth from 2 to 18 years of age (Fig. 1). The scientific data from 362 publications were presented in a condensed form of “seven steps”, very useful in diagnosing and treatment planning (1). The authors underline the limited number of the reliable evidence about SDB: prospective studies, randomized double-blinded studies with placebo. The presented evidence was categorized depending on their quality according to the classification of the American Academy of Neurology (ANN) into classes I – IV. Previously, in 2012, the guidelines of the American Academy of Pediatrics on obstructive sleep apnea syndrome (OSAS) in children with tonsillar hypertrophy and/or obesity were published (2, 3) and they were a valuable diagnostic and therapeutic compendium. The European guidelines discussed in this article result from the progress of knowledge in the recent years, they cover the subject broadly, consider rare and difficult cases and present the spectrum of potential therapeutic actions. The aim of the guidelines is a better recognition of SDB, a systematization of diagnosis and treatment at every stage of medical care, including the causes of this disorder and its complications.
3
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Effects of propofol and dexmedetomidine in sleep videoendoscopy: a comparative study in Ukraine

100%
Denysenko R., Dichtiaruk O., Naumenko O.
Polski Przegląd Otorynolaryngologiczny
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2020
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vol. 9(3)
12-16
EN
Introduction: Snoring and obstructive sleep apnea (OSA) are associate with a high socio-economic burden. According to statistics snoring is found in 44% of men and 28% of women aged 30 to 60 years. Treatment involves several main approaches including uvulopalatopharyngoplasty with or without tonsillectomy. Preparation for this procedure includes sleep videoendoscopy. Currently, we mainly use two effective agents, propofol and dexmedetomidine. That said, there is still no consensus on which one is safer and better. Material and methods: The study involved 50 people aged 18 to 62 with a history of snoring and OSA, previously ineligible or insensitive to CPAP therapy, thus preparing for surgical treatment of these disorders. All patients were randomized to two study groups: group 1 with propofol as a sedative and group 2 with dexmedetomidine. Each treatment was divided into three periods: (1) initial testing before the use of intravenous hypnotic agents, (2) sedation, and (3) regaining consciousness. In each period, we measured the following parameters: minute ventilation, respiratory rate, oxygen saturation, blood concentration of hypnotic agent, BIS index. Statistical analysis was performed on IBM SPSS Statistics v. 22. Results: The OAA/S scale showed that the recovery time after sedation was longer for dexmedetomidine than for propofol: 38 ± 10 min and 27 ± 3 min, respectively (p value = 0.305, which means no statistically significant difference between the groups). Based on monitoring of circulation and respiratory rate, heart rate tended to decrease with dexmedetomidine seda tion and increase with propofol infusion. Blood pressure tended to drop in both groups, more so with dexmedetomidine. In the post-sedation period, blood pressure stabilized faster in the propofol group than in the dexmedetomidine group, but it was not statistically significant. Conclusion: According to the study results, there was no statistically significant difference between the propofol or dexmedetomidine groups. However, the paper presents a small series of cases, therefore extensive clinical research is needed to clarify the problem further.
4
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Nd:YAG laser assisted uvulopalatoplasty in the treatment of obstructive sleep apnea syndrome

100%
Babiński D., Stankiewicz C., Kowalska B., Majkowicz M.
Otolaryngologia Polska
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2007
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vol. 61(3)
295-300
EN
Introduction. Surgical treatment of OSAS is focused on removal of narrowing that increase airway resistance in upper respiratory tract. Nd:YAG laser beam penetrates deeper into tissue than CO2 laser followed by superior scarification ability. In this study we investigate efficacy of surgery with Nd:YAG laser assisted uvuloplasty (LAUP). Material and methods. The subject was 51 patients with OSAS treated in Department of Otolaryngology, Medical University of Gdansk during the 2004–2005 period. All patients underwent all-night PSG and the ESS (Epworth Sleepiness Scale) score was used to assess the daytime sleepiness. Surgery treatment was performed and all patients underwent LAUP and additionally lingual base laser vaporization, tonsillectomy and nasal surgery where needed. The postoperative control ENT examination including ESS and all-night PSG was performed after 6 months. Results. Success was found in 29 patients, they achieved AHI<10 and ESS<12. In another 22 patients improvement at PSG parameters and ESS score were evaluated but they were still beyond normal range. Success was obtained in 14/16 patients with preoperative AHI I degree, 10/19 AHI II, and 4/16 AHI III. Nasal surgery for enlargement of airway passage was performed more frequently (25/32) in the group with success then in the group with partial improvement (9/19). Preoperative PSG parameters were better in patients with nasal obstruction. Patients with BMI≥30 succeeded rarely (10/22) in compare with patients with BMI<30 (success in 24/29). Preoperative PSG parameters were better in patients with BMI<30. Conclusion. LAUP with Nd:YAG laser wit additional tonsillectomy, lingual base surgery and nasal surgery were needed is successful method for surgery at light and medium stage of OSAS in nonobese patients.
5
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Histological evaluation of soft palate tissues in patients with sleep-disordered breathing

75%
Panek J., Reszeć J., Rogowski M., Olszewska E.
Polish Journal of Otolaryngology
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2020
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vol. 74
|
issue 1
6-12
EN
Introduction: Sleep is a physiological state essential for the proper functioning of the body. One of the reasons for its disturbance is obstructive sleep apnea syndrome (OSAS). Aim: The aim of this research is the histological evaluation of the soft palate in patients who suffered from various types of OSAS. Material and method: The study group consisted of patients with sleep-disordered breathing (SDB) in the form of primary snoring or OSAS. Patients with chronic tonsillitis, without a history of SDB, were included in the comparative group. Fragments of the mucous of the uvula (study group) and the palatoglossal pillar (comparative group) were obtained during surgery for histological evaluation. Using histological, histochemical and immunohistochemical methods, we assessed the inflammation and its severity (CD3, CD20, CD68), the structure of nerve fibers (S-100) and the size of blood vessels (CD34) in the examined tissue. Results: Patients with OSAS developed a local inflammatory process in the palatal tissues (stronger expression of CD3, CD20, CD68 in patients with OSAS). The severity of the immunohistochemical reaction with CD3 correlated with the stage of OSAS. A higher degree of fibrosis and a higher expression of CD34 and S-100 receptors were observed in patients with OSAS compared to snoring patients and patients from the comparative group. Conclusion: Most likely, snoring due to chronic tissue vibration leads to damage to the nerve fibers in the soft palate, which can intensify episodes of hypopneas during and increase the chance for sleep apneas.
6
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Histological evaluation of soft palate tissues in patients with sleep-disordered breathing

75%
Panek J., Reszeć J., Rogowski M., Olszewska E.
Otolaryngologia Polska
|
2020
|
vol. 74(1)
6-12
EN
Introduction: Sleep is a physiological state essential for the proper functioning of the body. One of the reasons for its disturbance is obstructive sleep apnea syndrome (OSAS). Aim: The aim of this research is the histological evaluation of the soft palate in patients who suffered from various types of OSAS. Material and method: The study group consisted of patients with sleep-disordered breathing (SDB) in the form of primary snoring or OSAS. Patients with chronic tonsillitis, without a history of SDB, were included in the comparative group. Fragments of the mucous of the uvula (study group) and the palatoglossal pillar (comparative group) were obtained during surgery for histological evaluation. Using histological, histochemical and immunohistochemical methods, we assessed the inflammation and its severity (CD3, CD20, CD68), the structure of nerve fibers (S-100) and the size of blood vessels (CD34) in the examined tissue. Results: Patients with OSAS developed a local inflammatory process in the palatal tissues (stronger expression of CD3, CD20, CD68 in patients with OSAS). The severity of the immunohistochemical reaction with CD3 correlated with the stage of OSAS. A higher degree of fibrosis and a higher expression of CD34 and S-100 receptors were observed in patients with OSAS compared to snoring patients and patients from the comparative group. Conclusion: Most likely, snoring due to chronic tissue vibration leads to damage to the nerve fibers in the soft palate, which can intensify episodes of hypopneas during and increase the chance for sleep apneas.
7
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Diagnostyka przesiewowa zaburzeń oddychania podczas snu u chorych z kardiomiopatią rozstrzeniową

63%
Ścierski W., Dola J., Maksym-Kulas B., Krzemień-Wolska K., Brzostowicz T., Kawecka I., Kawecki D.
Annales Academiae Medicae Silesiensis
|
2014
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vol. 68
|
issue 4
241-244
EN
BACKGROUND The findings of many studies on obstructive sleep apnea syndrome (OSA) indicate a relationship between OSA and cardiovascular diseases. The aim of the study was to evaluate the risk of breathing disorders in patients suffering from dilated cardiomyopathy. MATERIAL AND METHODS The study group comprised 51 patients with diagnosed dilated cardiomyopathy. The screening evaluation contains medical history data (snoring, excessive daytime somnolence), physical examination of laryngeal organs, BMI index and daytime somnolence Epworth scale. RESULTS Permanently or intemittently appearing snoring during sleep occurred in 30 patients. Three patients complained of daytime somnolence. In 22 cases during laryngological examination of the airways, patency disorders were found. Evaluation of the Epworth scale daytime somnolence showed results ranging from 0 to 12 with the average of 2.9 ± 2.5. The BMI index for all the patients was 26.59 ± 4.48. CONCLUSIONS The results of our study showed that in spite of the upper airway anatomical abnormalities in 22 patients coexisting with snoring during sleep (suggested OSA syndrome), no pathological daytime somnolence in the Epworth scale examination was found.
PL
W S T Ę P Wyniki wielu badań nad zespołem obturacyjnych bezdechów sennych wskazują na związek między tym schorzeniem a chorobami układu krążenia. Celem pracy była przesiewowa ocena ryzyka występowania zaburzeń oddychania podczas snu u chorych ze zdiagnozowaną kardiomiopatią rozstrzeniową. M A T E R I A Ł I M E T O D Y Zbadano grupę 51 chorych z rozpoznaną kardiomiopatią rozstrzeniową. Badania przesiewowe obejmowały dane zebrane z wywiadu (chrapanie, nadmierna senność w ciągu dnia), ocenę narządów laryngologicznych, ocenę senności dziennej skalą Epworth, wskaźnik BMI. WYNIKI Stałe lub okresowo pojawiające się chrapanie w czasie snu, które w istotny sposób zakłócało ciszę nocną występowało u 30 chorych. Objawy nadmiernej senności w ciągu dnia zgłaszało 3 chorych. W badaniu laryngologicznym u 22 chorych stwierdzono zaburzenia drożności w obrębie górnych dróg oddechowych. Badanie stopnia senności dziennej wykazało, iż wskaźnik Epworth wynosił od 0 do 12, średnio dla całej grupy 2,9 ± 2,5. Wskaźnik BMI dla całej grupy chorych wynosił 26,59 ± 4,48. WNIOSKI Mimo występowania u 22 chorych zaburzeń anatomicznych w obrębie górnych dróg oddechowych oraz objawów sugerujących zespół bezdechów sennych (chrapanie), nie stwierdziliśmy w badanej grupie patologicznej senności dziennej ocenianej skalą Epworth.
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