Adriane Iurck Zonato

Association of Systematic Head and Neck Physical Examination With Severity of Obstructive Sleep Apnea—Hypopnea Syndrome†

Objectives/Hypothesis To identify upper airway and craniofacial abnormalities is the principal goal of clinical examination in patients with obstructive sleep apnea–hypopnea syndrome. The aim was to identify anatomical abnormalities that could be seen during a simple physical examination and determine their correlation with apnea–hypopnea index (AHI).

Head and Neck Physical Examination: Comparison Between Nonapneic and Obstructive Sleep Apnea Patients†

Study Objectives: The purpose of this study was to apply a systematic physical examination, used to evaluate obstructive sleep apnea (OSA) patients, in nonapneic patients.

Obstructive sleep apnea in patients undergoing supracricoid horizontal or frontolateral vertical partial laryngectomy

OBJECTIVE: To assess obstructive sleep apnea (OSA) in patients undergoing supracricoid horizontal partial laryngectomy (SCPL) or frontolateral vertical partial laryngectomy (VPL) for the treatment of laryngeal carcinoma and correlate it with age, body mass index, physical examination, and upper airway evaluation. STUDY DESIGN AND SETTING: A prospective study was carried out involving 22 patients between 50 and 80 years of age divided into 2 equal groups. The patients underwent SCPL and VPL, and were evaluated by anamnesis, otolaryngologic examinations, nasopharyngolaryngoscopy, and polysomnography. RESULTS: A significant direct correlation was observed between the apnea/hypopnea index (AHI) and age of the patients. An inversely proportional relation was found between glottic opening and AHI. The presence of OSA was 81% in SCPL and 91% in VPL. CONCLUSION: We observed a high incidence of OSA in patients undergoing SCPL and VPL.

Indicação cirúrgica otorrinolaringológica em um ambulatório para pacientes com síndrome da apnéia e hipopnéia obstrutiva do sono

AIM: Otolaryngology surgical procedure is an option for obstructive sleep apnea-hypopnea syndrome (OSAHS) treatment. The objective of this study is to show which procedures can be done well as their indications. STUDY DESIGN: Clinical retrospective. METHOD: 223 patients with OSAHS were studied in Otolaryngology Department of UNIFESP. Every patient had a previous polissonography, and they were analyzed and treatment options were proposed. The treatment options were divided in no surgical (CPAP, dental appliance and general measures) and surgical procedures (pharynx surgery, rhinosurgery and maxillofacial surgery). RESULT: 100 patients (44,8%) had surgery indication, and 168 procedures were proposed. The majority uvulopalatopharyngoplasty and radiofrequency of the soft palate were indicated in mild and moderate OSAHS cases and maxillomandibular surgery were indicated in severe cases. Tonsillectomy and rhinosurgery were indicated independently of OSAHS severity. CONCLUSION: The otolaryngological surgery is an option in OSAHS treatment, and your indication depends on OSAHS severity. The surgical procedure can be done whit curative intetion or to avoid CPAP use.

A comparison of public and private obstructive sleep apnea clinics.

The aim of the present study was to compare the clinical findings and polysomnography results obtained at public and private clinics in Brazil, the follow-up after diagnosis, and the therapeutic aspects related to continuous positive airway pressure. Patients who snore and who have obstructive sleep apnea were retrospectively divided into two groups, i.e., public clinic (N=307) and private clinic (N=317). Data concerning age, sex, body mass index (BMI), neck circumference, medical history, sleepiness scale, follow-up after diagnosis, and acceptance of continuous positive airway pressure therapy were collected. Mean age was 50 +/- 12 (range: 15-80) for public patients and 48 +/- 12 years (range: 19-91) for private patients. Mean BMI was 30 +/- 6 (range: 19-67) for public patients and 31 +/- 6 kg/m (range: 21-59) for private patients. The public clinic had a significantly higher frequency of women than the private clinic (M:F ratio of 2.0:1 and 6.9:1, respectively). The condition of private patients (apnea-hypopnea index=31 +/- 25) was more severe than that of public patients (apnea-hypopnea index=25 +/- 24 events/h; P=0.0004). In the public and private clinics, 19 and 15% of patients were snorers, respectively, and 81 and 85% of them had sleep apnea. After diagnosis, follow-up was longer in the private group. The continuous positive airway pressure acceptance was similar for both groups (32 vs 35%), but patients from the public clinic abandoned treatment more than private ones (65 vs 13%). Social status was significant in terms of the severity of obstructive sleep apnea age and gender distribution. Private patients look for a diagnosis earlier in the course of the disease than public patients, adhere more to follow-up, and abandon continuous positive airway pressure treatment less than public patients do.

Application of the Kushida morphometric model in patients with sleep-disordered breathing

UNLABELLED The morphometric model is a useful screening test to investigate the possibility of OSAS in patients during initial office visits. AIM To evaluate the clinical applicability of the Kushida morphometric model in a sample of patients with sleep-disordered breathing, and to define a cutoff value to differentiate patients with mild, moderate and severe apnea. METHOD A sample of 80 patients with sleep respiratory disorder was studied. Patients were aged between 18 and 75 years, of both genders and had been submitted previously to polysomnography. The model cutoff value to distinguish between patients with or without apnea is 70. RESULTS In this sample, the model cutoff value in all four groups was less than 70. It was impossible to establish a cutoff value according to the gravity of the condition, due to the proximity and the nonlinear increase in the values presented by the nonapneic group and those with mild and moderate apnea. CONCLUSION The Kushida morphometric model can be applied in clinical practice to a selected sample and it was impossible to establish a cutoff value to separate patients with obstructive sleep apnea-hypopnea syndrome according to severity.

Snoring is not an exclusion criteria; It is placed into the obstructive sleep apnea category

We have read with great interest the article by Dr. Zonato et al. entitled “Head and Neck Physical Examination: Comparison Between Nonapneic and OSA Patients” in the June 2005 issue of The Laryngoscope.1 However, we are suspicious about the accuracy of the exclusion criterion applied for snoring patients in the nonapneic group. As it is defined at the study design of the article, exclusion criteria for the nonapneic group were apnea– hypopnea index (AHI) greater than 5 events/hour and AHI 5 or less events/hour with habitual snoring. So, nonapneic patients with habitual snoring are excluded from the nonapneic group and from the study under control in this research. There is a consensus concerning that obstructive sleep apnea (OSA) and snoring are different phenomenon and the patients with habitual snoring are expected to have some anatomic variations such as web palate, posterior palate, thick palate, long uvula, and voluminous lateral wall. It is obvious that this meaningless restriction for patients with habitual snoring had dramatically decreased the percent of nonapneic patients having the anatomic variations declared here and shown in Table III of the article. So, the statistical differences of anatomic variations between the nonapneic group and patients with OSA are not reliable. In summary, the conclusion of the article stating that “Head and neck physical examination considering oropharyngeal anatomic variations illustrated significant difference between nonapneic and OSA group” cannot be accepted.

The use of ultrasound evaluation in the diagnosis of peritonsillar abscess

Peritonsillar Abscess (PTA) and Peritonsillar Cellulitis (PTC) are very similar clinical conditions. The differential diagnosis between them is made by needle aspiration, a very painful and invasive method. This study was performed at the Department of Otolaryngology at the Clinical Hospital of São Paulo University Medical School. Its aim was to evaluate the use of ultrasound as a noninvasive and inexpensive method of diagnosis, differentiating abscess from cellulitis. Twenty-one consecutive patients with a clinical diagnosis of peritonsillar infection were evaluated in the emergency service with a probable diagnosis of PTA. These patients were evaluated with intraoral and percutaneous ultrasound. Needle aspiration was used to compare and confirm the diagnosis. The sensitivity was 92.3% and specificity was 62.3%. The authors conclude that ultrasound is a good method to evaluate the differences between PTA and PTC.