Justin M. Wei

Hyoid surgery alone for obstructive sleep apnea: A systematic review and meta-analysis.

The primary objective was to determine if sleep study variables (e.g., apnea‐hypopnea index [AHI] and lowest oxygen saturation) and quantitative sleepiness data improve following isolated hyoid surgery for obstructive sleep apnea (OSA).

Oropharyngeal and tongue exercises (myofunctional therapy) for snoring: a systematic review and meta-analysis

PurposeOropharyngeal and tongue exercises (myofunctional therapy) have been shown to improve obstructive sleep apnea. However, to our knowledge, a systematic review has not been performed for snoring. The study objective is to perform a systematic review, with a meta-analysis, dedicated to snoring outcomes after myofunctional therapy.MethodsPubMed/MEDLINE and three other databases were searched through November 25, 2017. Two authors independently searched the literature. Eligibility (1) patients: children or adults with snoring, (2) intervention: oropharyngeal and/or tongue exercises, (3) comparison: pre and post-treatment data for snoring, (4) outcomes: snoring frequency and snoring intensity, (5) study design: publications of all study designs.ResultsA total of 483 articles were screened, 56 were downloaded in their full text form, and nine studies reported outcomes related to snoring. There were a total of 211 patients (all adults) in these studies. The snoring intensity was reduced by 51% in 80 patients from pre-therapy to post-therapy visual analog scale values of 8.2 ± 2.1 (95% CI 7.7, 8.7) to 4.0 ± 3.7 (95% CI 3.2, 4.8). Berlin questionnaire snoring intensity reduced by 36% in 34 patients from 2.5 ± 1.0 (95% CI 2.2, 2.8) to 1.6 ± 0.8 (95% CI 1.3, 1.9). Finally, time spent snoring during sleep was reduced by 31% in 60 patients from 26.3 ± 18.7% (95% CI 21.6, 31.0) to 18.1 ± 20.5% (95% CI 12.9, 23.3) of total sleep time.ConclusionsThis systematic review demonstrated that myofunctional therapy has reduced snoring in adults based on both subjective questionnaires and objective sleep studies.

Protein Misfolding in Alzheimer s Disease and Sleep Related Disorders

Some studies have indicated a relationship between the development of Alzheimers Disease (AD) and having obstructive sleep apnea (OSA), while others argue that AD itself leads to sleep disturbances and sleep disordered breathing. Whether peripheral due to the direct effects of abnormal protein aggregation or central due to the systemic effects of Beta - A aggregation in functionally important areas of the central nervous system, there seems to be an association between misfolded protein and sleep disordered breathing. These findings from studies into another proteopathy lends further credence to the revelations reported from the prion related research and brings us closer to understanding the disease mechanism behind both OSA and protein misfolding. The conglomeration of findings from studies into proteopathies clearly provides significant impetus into continuing research in proteopathies to improve our understanding of not only sleep disordered breathing but the enigma that is proteopathy.

Double Barrel Nasal Trumpets to Prevent Upper Airway Obstruction after Nasal and Non-Nasal Surgery

Objectives During anesthesia emergence, patients are extubated and the upper airway can become vulnerable to obstruction. Nasal trumpets can help prevent obstruction. However, we have found no manuscript describing how to place nasal trumpets after nasal surgery (septoplasties or septorhinoplasties), likely because (1) the lack of space with nasal splints in place and (2) surgeons may fear that removing the trumpets could displace the splints. The objective of this manuscript is to describe how to place nasal trumpets even with nasal splints in place. Materials and Methods The authors describe techniques (Double Barrel Technique and Modified Double Barrel Technique) that were developed over three years ago and have been used in patients with obstructive sleep apnea (OSA) and other patients who had collapsible or narrow upper airways (i.e., morbidly obese patients). Results The technique described in the manuscript provides a method for placing one long and one short nasal trumpet in a manner that helps prevent postoperative upper airway obstruction. The modified version describes a method for placing nasal trumpets even when there are nasal splints in place. Over one-hundred patients have had nasal trumpets placed without postoperative oxygen desaturations. Conclusions The Double Barrel Technique allows for a safe emergence from anesthesia in patients predisposed to upper airway obstruction (such as in obstructive sleep apnea and morbidly obese patients). To our knowledge, the Modified Double Barrel Technique is the first description for the use of nasal trumpets in patients who had nasal surgery and who have nasal splints in place.

In response to "Hyoid Surgery Alone for Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis".

We would like to thank Dr. Fox and Dr. Takashima for their interest in our article “Hyoid Surgery Alone for Obstructive Sleep Apnea: A Systematic Review and Meta-analysis.” We undertook the study in order to identify how effective hyoid surgeries are based on the international literature. The authors make two important points: First, in the article by Riley et al. in 1984, the technique utilized hyoid myotomy with mandibular suspension, whereas the article by Riley and Powell in 1994 describes the modified hyoid suspension (hyothyroidopexy). Despite having at least two authors review all the articles, we missed this important finding, likely because Figure 1 in the article by Riley and Powell in 1994 demonstrates the mandibular osteotomy with genioglossus advancement and hyoid suspension, which we believe is what led to our error in categorization. Second, regarding the study by Holzl et al., in our word-by-word translation we did not encounter nasal surgery in the article; however, there was a reference to nasal continuous positive airway pressure (CPAP) on page 716. Additionally, we agree after re-review that Holzl et al. performed variations of hyoid surgeries and did not substratify the outcomes; therefore, the data should be viewed as contributing to the outcomes for isolated hyoid surgeries as a broad category. Based on the re-categorizing and the findings by the researchers in the Letter to the Editor, it does seem more likely that hyothyroidpexy alone would reduce apnea-hypopnea index (AHI) less (32.1% reduction) when compared to the more involved hyoid myotomy with suspension (35.5% reduction). It is interesting to note that the effect of either surgery reduces the AHI by about one-third. A major goal of the authors of this and other sleep surgery and medicine systematic reviews and metaanalyses is to help determine the outcomes for isolated obstructive sleep apnea (OSA) treatments such as supraglottoplasty and tonsillectomy. By providing outcomes for isolated OSA treatments, we will all be able to better counsel patients on current treatment options, and the research may also potentially stimulate innovative techniques or treatments for OSA. We again would like to thank the attention to detail that Dr. Fox and Dr. Takashima have provided and appreciate the respectful and collegial tone of their letter to the editor. Disclaimer: The views expressed in this manuscript are those of the authors and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the U.S. Government.

Recent Updates to Soft Palate Surgery for Treatment of Obstructive Sleep Apnea

Purpose of ReviewThis study aims to provide an update on surgical modalities targeted specifically at the soft palate as treatment for obstructive sleep apnea (OSA). OSA is an ever-changing field with advancements in not only medical management but also surgical interventions that continue to add to the plethora of treatment options. Though a multitude of surgical treatment modalities exist, the most commonly used technique involved remains the uvulopalatopharyngoplasty (UPPP).Recent FindingsWhile over 100 articles were initially identified, many were excluded due to combination of other surgical techniques. Fewer than 20 studies evaluated surgery on the soft palate alone. This manuscript summarizes the techniques presented over the past 3 years.SummaryThis review of the literature failed to identify any new developments improving consistency of efficacy of the surgical techniques directed towards the soft palate.