Hsueh-Yu Li

Improvement in Quality of Life After Nasal Surgery Alone for Patients With Obstructive Sleep Apnea and Nasal Obstruction

OBJECTIVEnTo evaluate the impact of nasal surgery alone on quality of life (QOL) in patients with obstructive sleep apnea and nasal obstruction using generic and disease-specific QOL questionnaires.nnnDESIGNnProspective, longitudinal cohort study.nnnPATIENTSnFifty-one consecutive patients with obstructive sleep apnea (50 men and 1 woman; mean age, 39 years; mean [SD] apnea-hypopnea index, 37.4 [28.9] events/h; and mean +/- SD body mass index [calculated as weight in kilograms divided by height in meters squared], 26.0 [3.5]) with symptoms of nasal obstruction due to a deviated nasal septum.nnnINTERVENTIONnSeptomeatoplasty.nnnOUTCOME MEASURESnSurgical outcomes were measured using the Snore Outcomes Survey, the Epworth Sleepiness Scale, and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) 3 months after surgery. We compared baseline and postoperative scores. Normative SF-36 data obtained from 4591 age- and sex-matched adults were used as references.nnnRESULTSnNasal obstruction symptoms significantly improved (mean [SD] visual analog scale score, -5.2 [1.4]; P < .001). Assessments also showed significant improvement in the Snore Outcomes Survey (P < .001) and Epworth Sleepiness Scale (P < .001) scores and 6 of the 8 SF-36 subscale scores (P < .05). Remarkable improvements were observed in disease-specific Snore Outcomes Survey (by 43.1%), Epworth Sleepiness Scale (by 27.3%), and generic SF-36 role-emotional (by 30.4%) and role-physical (by 20.7%) QOL subscales. The postoperative role-emotional, bodily pain, and social function dimensions of health were indistinguishable from referential population data (P > .05).nnnCONCLUSIONSnCorrection of an obstructed nasal airway significantly improves disease-specific and generic QOL in adult patients with obstructive sleep apnea who also have nasal obstruction symptoms. After nasal surgery, patients may experience greater improvement in snoring and daytime sleepiness than in other generic health status. Our findings substantiate the role of nasal surgery in treating patients with obstructive sleep apnea and nasal obstruction.

The prevalence of restless legs syndrome in Taiwanese adults

Aim:u2002 Few studies have examined the prevalence of restless legs syndrome (RLS) in Asian populations, with existing data suggesting substantially lower rates of RLS in Asian populations compared with Caucasians. However, varying definitions of RLS as well as problematic methodology make conclusions about RLS prevalence in Asian populations difficult to interpret. The current study therefore examines the prevalence of RLS in Taiwanese adults.

Same-stage palatopharyngeal and hypopharyngeal surgery for severe obstructive sleep apnea

Objectives To investigate surgical outcomes with two types of combined palatopharyngeal and hypopharyngeal surgery for the treatment of severe obstructive sleep apnea (OSA). Material and methods Twelve consecutive OSA patients with a respiratory disturbance index (RDI) >30/h and Fujita type II anatomy were enrolled. Patients were divided into two groups according to their fiberscopic manifestations. Six patients with obstruction at the uvulopalatal complex and tongue base (Group 1) were selected for extended uvulopalatal flap (EUPF) and midline laser glossectomy (MLG). EUPF and laser lingual tonsillectomy were performed in another six patients shown to have obstruction at the uvulopalatal complex and lingual tonsil (Group 2). Polysomnographic parameters included the RDI and minimal oxygen saturation (MSAT). Surgical success was defined as a postoperative RDI of <20/h and a >50% reduction in the preoperative RDI. Results Six months postoperatively, 5 patients (83.3%) had responded successfully in Group 1 and none in Group 2. In Group 1 the mean RDI decreased from 50.7±12.6 to 8±14.3 (95% CI 23.0−62.7; p<0.01) and MSAT increased from 76.3%±11.6% to 88.8%±3.2% (95% CI −25.9–0.87; p=0.06). There was no improvement in sleep parameters in Group 2 patients. No persistent nasal regurgitation, swallowing disturbance or change in taste was noted at 1-year follow-up in either group. Conclusions EUPF combined with MLG improves OSA in Fujita type II patients. The hypertrophic lingual tonsil, although obscure the laryngeal structure, did not contribute significantly to OSA.

High Incidence of Malignant Transformation of Laryngeal Papilloma in Taiwan

Objectives: Papillomas of the larynx include solitary laryngeal papilloma and recurrent respiratory papillomatosis. This study investigated the incidence of malignant transformation and assessed possible risk factors for laryngeal papillomas.

Highly potent and specific siRNAs against E6 or E7 genes of HPV16- or HPV18-infected cervical cancers

Infection with high-risk types (type 16 or type 18) of human papillomaviruses (HPVs) increases a patients risk of cervical cancer. Given the importance of the cervix and the severe side effects resulting from traditional cancer therapies, this study aimed to achieve targeted inhibition of viral oncogenes in tumor cells using small interfering RNAs (siRNA). To accomplish this, we developed nine siRNAs against either the E6 or E7 genes of HPV-16 or HPV-18 in several combinations, yielding siRNAs targeting 16E6, 16E7, 18E6 and 18E7. We measured the effectiveness of the siRNAs by examining E6 or E7 mRNA expression after transfection of the siRNAs into HPV-positive CaSki (HPV-16) or HeLa (HPV-18) cell lines. We found that the HPV-siRNAs significantly reduced cell growth and colony formation in both cell lines. Flow cytometry analysis revealed a significant increase in apoptosis. The siRNAs had no effect on cell growth, colony formation or apoptosis in HPV-negative C33A cells, demonstrating a lack of off-target effects. In addition, an in vivo xenograft study showed that intra-tumoral injection of the siRNAs reduced tumor growth in BALB/c nude mice. In conclusion, we have developed highly specific and potent HPV-siRNAs that successfully suppress tumor growth and induce apoptosis in HPV-positive cervical cancer cells. siRNA treatment has potential for further development as an adjuvant therapy for cervical cancer.

Nasal Surgery for Snoring in Patients With Obstructive Sleep Apnea

Objective: To evaluate the efficacy of nasal surgery to relieve snoring and to identify predictive factors.

Quality of Life Measures and Predictors for Adults With Unilateral Vocal Cord Paralysis

Objective/Hypothesis: To investigate the quality of life (QoLF) status of Taiwanese adults with unilateral vocal cord paralysis (UVCP).

Validation assessment of the Chinese version of the Snore Outcomes Survey

The aim of this study was to use a parallel model to translate the Snore Outcomes Survey (SOS) into Mandarin Chinese language by comparing performing characteristics and statistical properties of the original and Chinese versions SOS. The Chinese version SOS (CSOS) was validated in a prospective, non-randomized manner. A total of 359 patients with sleep-disordered breathing (SDB) aged 18 years and older diagnosed as having SDB participated in the study at entry. Reliability, validity, and longitudinal sensitivity data for CSOS were obtained. CSOS demonstrated good test–retest reliability (Intra-class correlation coefficient = 0.751). The Cronbachs α coefficient was 0.86. The item–total correlation coefficients varied from 0.30 to 0.99. The CSOS correlated well with polysomnogram (PSG) parameters including respiratory distress index (RDI), lowest arterial O2 saturation (LAST). CSOS also yielded significant correlations with vitality subscale of Chinese Taiwan version SF-36 (r = 0.4, p = 0.0011). The standard response mean (SRM) for CSOS was 1.33. The validation demonstrated only minor effects of language; the statistical properties of the CSOS were equivalent to the English version. The CSOS is a valid tool to evaluate adults with SDB among Chinese-speaking population.

Outcomes of Fat Injection Laryngoplasty in Unilateral Vocal Cord Paralysis

OBJECTIVEnTo analyze outcomes following fat injection laryngoplasty in patients with unilateral vocal cord paralysis.nnnDESIGNnLongitudinal outcomes evaluation study.nnnSETTINGnTertiary referral voice center.nnnPATIENTSnThirty-three consecutive patients with unilateral vocal cord paralysis undergoing autologous fat injection laryngoplasty with preoperative and serial postoperative follow-up at Chang Gung Memorial Hospital, Taipei, Taiwan.nnnINTERVENTIONnAutologous fat injection laryngoplasty.nnnMAIN OUTCOME MEASURESnVoice laboratory measurements, Voice Outcome Survey, and 36-item Short Form Health Survey.nnnRESULTSnExcept for the physical functioning dimension of global health, voice-related subjective outcomes and acoustic variables of the patients significantly improved after surgery (P < .05). Compared with population norms, the mean (SD) scores of patients were inferior on the 36-item Short Form Health Survey dimensions of physical functioning (80.7 [22.3] vs 90.2 [17.4]) and role functioning-physical problems (65.0 [36.2] vs 80.2 [36.2]). Overall, 88.9% (24 of 27) of the patients were satisfied with their surgery.nnnCONCLUSIONSnFat injection laryngoplasty seems to be effective in enhancing acoustic and quality of life outcomes in patients with unilateral vocal cord paralysis. The effect is sustainable over 12 months.

Patients with severe obstructive sleep apnea syndrome and elevated high-sensitivity C-reactive protein need priority treatment.

Objective: To evaluate the clinical factors predicting the significantly elevated high-sensitivity C-reactive protein (hs-CRP) concentrations, defined herein as hs-CRP ≥ 3 mg/L, in adult males with untreated obstructive sleep apnea syndrome (OSAS). Study Design: Cross-sectional study. Setting: Tertiary referral center. Subjects and Methods: Sixty-five consecutive male patients with newly diagnosed OSAS were enrolled to receive complete medical history review, physical examination, in-laboratory overnight polysomnography, and hs-CRP test. The patients had no current or history of cardiovascular disease. The patients had a mean age of 38.2 ± 9.9 years, body mass index (BMI) of 27.4 ± 3.5 kg/m2, and Epworth Sleepiness Scale (ESS) of 11.3 ± 4.6. The serum levels of hs-CRP were assessed using peripheral venous blood samples. Results: Twenty-three percent of the overall patients had significantly elevated serum levels of hs-CRP. The increase of hs-CRP correlated fairly with BMI, apnea-hypopnea index (AHI), tonsil size, and ESS (r = 0.450, 0.398, 0.393, and 0.300, respectively; all P ≤ 0.05) after adjustment for conventional coronary heart disease risk factors. However, only the AHI could predict for significantly elevated hs-CRP after stepwise multiple linear regression (R 2 = 0.251, P < 0.001). Conclusion: Patients in this study with hs-CRP ≥ 3 mg/L were more prevalent in the severe OSAS group. This observation suggests that the severe OSAS patients need to have their cardiovascular statuses evaluated by use of an hs-CRP screening test.