Paraya Assanasen

Epworth sleepiness scale in obstructive sleep disordered breathing: the reliability and validity of the Thai version

PurposesThe objectives of this study are to test the reliability and validity of the Thai version of the Epworth sleepiness scale (ESS) and to assess the relationship between the ESS score and the severity of obstructive sleep disordered breathing.MethodsA total of 228 subjects (149 males and 79 females) were recruited. In order to check the discriminant validity of the ESS, we included 32 healthy volunteers and 39 patients with primary snoring to be the control groups and 126 patients with obstructive sleep apnea (OSA) confirmed by full polysomnography to be the disease groups. The test–retest reliability was investigated in 71 subjects. To check the responsiveness properties of the questionnaire, we asked a separate group of 31 patients who were successfully treated with either continuous positive airway pressure (CPAP) or upper airway surgery to complete the ESS before and after treatment at 3–6xa0months.ResultsThe internal consistency demonstrated by Cronbach’s alpha coefficients for standardized item was 0.87 and a range from 0.84 to 0.86 if some items were deleted. The test–retest reliability was shown by intra-class correlation coefficients of 0.79. There was a statistically significant difference between the mean of the ESS scores of the control groups (6.1u2009±u20093.0) and the OSA patients (9.9u2009±u20095.3) (pu2009<u20090.001). The ESS scores decreased significantly after a successful treatment with both CPAP and surgery (pu2009<u20090.001); however, there was no statistically significant difference among different severities of OSA.ConclusionsOur Thai version of the ESS showed an excellent internal consistency and test–retest reliability. It is able to discriminate between control subjects and OSA patients and to assess the response of treatment; however, it has a weak relationship with the apnea–hypopnea index. Therefore, we recommend use it to combine with more comprehensive clinical evaluation in obstructive sleep disordered breathing patients.

Adjustable thermoplastic mandibular advancement device for obstructive sleep apnea: Outcomes and practicability

To assess outcomes including efficacy, adverse effects, and quality of life (QOL) of an adjustable thermoplastic mandibular advancement device (AT‐MAD) fitted by an otolaryngologist for obstructive sleep apnea (OSA) treatment.

Physical predictors for moderate to severe obstructive sleep apnea in snoring patients

PurposeThis study aimed to identify physical findings that may predict the presence of moderate to severe obstructive sleep apnea (OSA) in snoring patients.MethodsA total of 283 subjects (165 males and 118 females) were recruited, including 217 OSA patients and 66 patients with apnea–hypopnea index (AHI)u2009<u20095 as a control group, diagnosed by level-1 polysomnography. Baseline data of patients including age, sex, weight, height, body mass index (BMI), neck circumference (NC), waist circumference (WC), neck-to-height ratio (NHtR), and waist-to-height ratio (WHtR) were recorded. Other physical parameters such as chin length (Chin1), thyromental distance, hyomental distance, cricomental distance, cricomental space (CMS), Friedman tongue position (FTP), and tonsils size were recorded by a single investigator who was blinded to the PSG results.ResultsThe findings that were statistically different between the control group and moderate to severe OSA (AHIu2009≥u200915) included sex, BMI, NC, NHtR, WC, WHtR, Chin1, CM, and CMS (pu2009<u20090.05). However, logistic regression analysis showed that only male gender and WHtRu2009≥u20090.55 were the independent predictors for AHIu2009≥u200915 with adjusted odds ratios of 6.6 and 3.1, respectively.ConclusionAmong snoring patients seeking medical consultation, male gender and WHtR ofu2009≥u20090.55 were good predictors for moderate to severe OSA. No single head and neck finding reliably predicted this condition. In a situation with limited facilities, these data along with medical history may be helpful for prioritizing patients in order to achieve the optimal use of sleep investigation and treatment.

Functional outcomes of sleep in Thai patients with obstructive sleep-disordered breathing

PurposesQuality of life assessment in obstructive sleep-disordered breathing (OSDB) is increasingly recognized, and the functional outcomes of sleep questionnaire (FOSQ) is a popular instrument. The objective of this study was to apply this questionnaire in Thai patients to assess its reliability, validity, and responsiveness properties.MethodsA total of 223 subjects were recruited. The scores of FOSQ in 38 healthy volunteers and 40 primary snorers were compared with those of 108 obstructive sleep apnea (OSA) patients diagnosed by polysomnography. Seventy-two subjects answered the FOSQ twice at 2–4xa0weeks apart to check the test–retest reliability, and 37 patients with OSA who complied well with CPAP therapy answered them again after treatment at 3–6xa0months. All participants also filled the Epworth sleepiness scales (ESS) to check the concurrent validity.ResultsThere were statistically significant differences in all FOSQ subscales including global scores between healthy volunteers (17.3u2009±u20092.1) and OSA patients (14.5u2009±u20092.9) (pu2009<u20090.001). The internal consistency of the questionnaire was excellent (Cronbachs alpha 0.95), and the test–retest reliability (intra-class correlation coefficients) was 0.70 in global scores. After adequate CPAP therapy, all FOSQ scores increased significantly (pu2009<u20090.001) There were significant correlations between all FOSQ scores except sexual relationship and ESS (r −0.48); however, these had only a weak relationship with AHI and minimal oxygen saturation.ConclusionsThe FOSQ can be applied to Thai patients with OSDB with good reliability, validity, and responsiveness properties. It may be the first validated version of FOSQ in East Asian countries which is a very useful tool for future research.

Radiofrequency inferior turbinate reduction improves smell ability of patients with chronic rhinitis and inferior turbinate hypertrophy

Radiofrequency inferior turbinate reduction (RFITR) of inferior turbinate hypertrophy (ITH) is an effective way to treat patients with intractable nasal mucosal obstruction. The objective of this study was to assess smell ability, nasal symptoms, inferior turbinate grading (ITG), peak nasal inspiratory flow (PNIF) of patients with chronic rhinitis (CR), and ITH before and after RFITR. Patients with CR and ITH, aged 18–60 years, who underwent RFITR, were prospectively recruited. Smell ability (measured by smell detection threshold [SDT]), visual analog scale (VAS) of nasal symptoms, ITG, and PNIF before and 6–10 weeks after RFITR were compared. Forty-eight subjects were included. All nasal symptoms were significantly decreased after RFITR. After surgery, SDT (tested by phenyl ethyl alcohol) was worsened in 7 patients (14.6%), improved in 8 patients (16.7%), and did not change in 33 patients (68.7%). SDT after RFITR of six patients in the worsened SDT group were still within normal range (> −6.5). There was only one patient whose SDT changed from normosmia to mild hyposmia (–7.25 to −5.38). In the improved SDT group, two of eight patients had obviously better SDT after RFITR, which changed from moderate hyposmia to normosmia (–3.65 to −10; −3.73 to −10), whereas six of eight patients had little better SDT after RFITR. RFITR also significantly reduced ITG and improved PNIF. In conclusion, the treatment of patients with CR and ITH with RFITR significantly improved PNIF, ITG, and nasal symptoms assessed by VAS, although SDT after RFITR could be the same or improved or worsened.

Combined radiofrequency volumetric tissue reduction and lateral outfracture of hypertrophic inferior turbinate in the treatment of chronic rhinitis: short-term and long-term outcome.

Radiofrequency volumetric tissue reduction (RFVTR) of hypertrophic inferior turbinate (IT) is an effective way to treat patients with intractable nasal mucosal obstruction. We evaluated the effectiveness of combined RFVTR and lateral outfracture (LO) of hypertrophic IT in chronic rhinitis (CR) patients on reduction of nasal obstruction, rhinorrhea, and nasal pruritus both short and long term.

Adjustable thermoplastic oral appliance versus positive airway pressure for obstructive sleep apnea

To compare outcomes of continuous positive airway pressure (CPAP) and the adjustable thermoplastic mandibular advancement splint (AT‐MAS) for obstructive sleep apnea treatment.

A randomized study of temperature-controlled versus bipolar radiofrequency for inferior turbinate reduction

The objective of this study is to compare outcomes of temperature-controlled radiofrequency (TCRF) and bipolar radiofrequency (BRF) for inferior turbinate reduction in patients with chronic rhinitis (CR). This was a prospective, randomized non-inferiority trial. Eighty-four adult patients with CR refractory to medication were randomized into two intervention groups: TCRF(42) or BRF(42). Primary outcomes consisted of patient-orientated visual analog scale (VAS; 0–10) of nasal obstruction at 4th postoperative week. Secondary subjective outcomes included VAS of nasal discharge, sneezing, hyposmia, and postnasal drip. Objective outcomes included crusting, mucociliary transportation time, minimal cross-sectional area, total nasal volume, and nasal airway resistance performed by blind assessors before and at 4th postoperative week and 1-year follow-up. Baseline and perioperative data showed no statistically significant difference between both groups, except for longer operative time in TCRF (481.5xa0±xa036.2 vs. 37.1xa0±xa03.0xa0s, pxa0<xa00.001) and slightly more crusts in BRF group (pxa0=xa00.04). Both intention-to-treat and per-protocol analyses, TCRF(39) versus BRF(41), revealed no significant difference among subjective and objective outcomes between two groups at 4th postoperative week. The 95xa0% confidence intervals of mean differences of VAS scores of all subjective symptoms were within defined margin (−1.5 to 1.5), except for nasal discharge. At 1-year follow-up, there was still no significant difference in the outcomes. Minimal pain and minor bleeding without serious adverse effects from both interventions were reported. Both BRF and TCRF resulted in similar short-term outcomes, while less operative time was found in BRF group. Further studies, particularly, on cost-effectiveness should be conducted for better treatment selection.Level of evidence1b.