Sungjin A. Song

Dexmedetomidine versus propofol during drug-induced sleep endoscopy and sedation: a systematic review

BackgroundThe purpose of the present study is to review the international literature, using a systematic review, for studies comparing propofol and dexmedetomidine for drug-induced sleep endoscopy (DISE) or sedation in which there is a description of the effect of the agents on the upper airway and associated variables (e.g., vital signs, sedation scores).MethodsThis is a systematic review through October 4, 2016. PubMed/MEDLINE and four additional databases were accessed for this study.ResultsTwo hundred twenty studies were screened, 79 were downloaded, and 10 met criteria. The majority of the studies identified dexmedetomidine as the preferred pharmacologic agent for DISE due to an overall safer and more stable profile based upon hemodynamic stability. However, propofol provided greater airway obstruction with oxygen desaturations. With either agent, the degree of obstruction in the upper airway lacks some degree of validity as to whether the obstructions accurately represent natural sleep or are simply a drug-induced effect.ConclusionDexmedetomidine and propofol have their advantages and disadvantages during DISE. Generally, dexmedetomidine was preferred and seemed to provide a more stable profile based upon cardiopulmonary status. However, propofol has a quicker onset, has a shorter half-life, and can demonstrate larger degrees of obstruction, which might more accurately reflect what happens during REM sleep. Additional research is recommended.

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).

Rapid maxillary expansion for pediatric obstructive sleep apnea: A systematic review and meta-analysis

To perform a systematic review with meta‐analysis for sleep study outcomes in children who have undergone rapid maxillary expansion (RME) as treatment for obstructive sleep apnea (OSA).

Laser-Assisted Uvulopalatoplasty for Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis

Study Objectives Laser-assisted uvulopalatoplasty (LAUP) has been used as treatment for obstructive sleep apnea (OSA). The objective of this study was to perform a systematic review and meta-analysis for LAUP alone as treatment for OSA in adults. Methods Three authors searched five databases (including PubMed/MEDLINE) from inception through October 30, 2016 for peer-reviewed studies, with any design/language. A study quality assessment tool was used. The PRISMA statement was followed. A meta-analysis was performed. Results Twenty-three adult studies (717 patients) reported outcomes (age: 50 ± 9 years, body mass index: 29 ± 4 kg/m2). The pre- and post-LAUP means (M) ± standard deviations (SDs) for apnea-hypopnea index (AHI) were 28 ± 13 and 19 ± 12 events/h (32% reduction). Random effects modeling for 519 patients demonstrated an AHI mean difference (MD) of -6.56 [95% CI -10.14, -2.97] events/h. Individual patient data analyses demonstrate a 23% success rate (≥50% reduction in AHI and <20 events/h) and an 8% cure rate. Additionally, 44% of patients had worsening of their AHI after LAUP. Lowest oxygen saturation (LSAT) improved from a M ± SD of 80 ± 8% to 82 ± 7%. A limitation is that most studies were case series studies and only two were randomized controlled trials. Conclusions In this meta-analysis, LAUP reduced AHI by 32% among all patients; while the LSAT only changed minimally. Individual data demonstrated a success rate of 23%, cure rate of 8%, and worsening of the AHI among 44% of patients. We recommend that LAUP be performed with caution or not performed at all given the unfavorable results of currently published studies.

Neurocognitive outcomes after pediatric adenotonsillectomy for obstructive sleep apnea: A systematic review and meta-analysis

OBJECTIVE To provide an up-to-date systematic review and critical appraisal of prospectively performed studies evaluating neurocognitive function in children treated with adenotonsillectomy. DATA SOURCES PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library. REVIEW METHODS Searches were performed from inception through September 2, 2015. RESULTS Nineteen prospective studies (898 adenotonsillectomy patients) met criteria and reported neurocognitive outcomes. The average age of children was 6.6±2.3 years (range 2.5-14 years) and 51.1% were male. Pre- and post-operative data utilizing the Neuropsychological Developmental Assessment score demonstrated an increase from a means±standard deviations of 101.5±14.7 [95% CI 100.0, 103.0] to 108.8±13.4 [95% CI 107.4, 110.2], p-value <0.0001 (375 children, three studies). Pre- and post-operative data utilizing the Stanford-Binet Intelligence Scales (IQ) demonstrated an increase in IQ scores from a means±standard deviations of 97.1±13.8 [95% CI 91.6, 95.4] to 100.7±11.1 [95% CI 100.4, 103.4], p-value <0.0001 (254 children, three studies). The mean pre- and post-adenotonsillectomy apnea-hypopnea index (AHI) decreased from 8.0 to 1.8 (274 children, six studies). CONCLUSIONS This meta-analysis found an improvement in neurocognitive function and IQ after pediatric adenotonsillectomy, especially in pre-school aged children. However, this must be interpreted with caution as only three studies were performed in pre-school aged children. The decreased effectiveness in older children suggests possibly a threshold age when neurocognitive deficits become irreversible.

Genial tubercle advancement and genioplasty for obstructive sleep apnea: A systematic review and meta-analysis.

To perform a systematic review and meta‐analysis for studies evaluating genioplasty alone, genial tubercle advancement (GTA) alone, and GTA with hyoid surgery (GTA‐HS) to treat obstructive sleep apnea (OSA).

Oral pressure therapy (winx) for obstructive sleep apnea: a meta-analysis updating the systematic review.

Letter to the editor: We read with great interest the recent systematic review by Dr. Nigam and colleagues evaluating the effect of oral pressure therapy (Winx® Sleep Therapy System by ApniCureTM Redwood City, CA, USA) on obstructive sleep apnea (OSA) outcomes [1]. We commend the authors for their role in advancing the academic literature regarding treatment for OSA. We believe this article would be strengthened by inclusion of a meta-analysis of the data, as has previously been published for other medical treatments (e.g. myofunctional therapy [2] and nasal expiratory positive airway pressure devices [3] (Provent ®)) and surgical treatments (e.g. hyoid surgery [4] and supraglottoplasty surgery [5]) for OSA. We, therefore, offer this additional statistical analysis for oral pressure therapy. In order to perform the meta-analysis, we first reviewed the article by Dr. Nigam and colleagues and downloaded the included manuscripts. Subsequently, M.C. and S.A.S. performed an updated search through February 10, 2016 to ensure there were no additional studies. We found no additional studies. We reviewed the studies and did our best to exclude studies if they had potentially duplicate data. Next, we used STATA 14.1 (StataCorp, College Station, Texas, USA) and Review Manager Software (REVMAN) version 5.3 (Copenhagen: The Nordic Cochrane Centre: The Cochrane Collaboration, 2014) to perform the statistical analysis and the meta-analysis with random effects modeling. In total, 140 patients had pre and post-oral pressure therapy data for evaluation. The means and standard deviations for apnea-hypopnea index (AHI) preand post-oral pressure therapy treatment for adults was 37.18 ± 24.94 and 21.35 ± 23.72 events/h (relative reduction: 42.6 %). Random effects modeling was performed for the studies providing means and standard deviations in 139 patients (1 patient was excluded as a case report since case reports have no mean and standard deviation, therefore, case reports cannot be analyzed in REVMAN). For AHI, the mean difference was −16.11 [95 % Confidence Interval (CI) -21.53, −10.68] events/h, overall effect z = 5.83, p < 0.00001. The Cochrane Q-statistic for mean difference in AHI was 0.40 (no statistically significant heterogeneity) and the I was 0 % (no inconsistency). The standardized mean difference for AHI was −0.69 [95 % CI −0.97, −0.41], which corresponds to a moderate magnitude of effect using Cohen’s guidelines. The Cochrane Q-statistic for standardized mean difference was 0.31 (no statistically significant heterogeneity) and the I was 16 % (no to low inconsistency). Figure 1 summarizes the mean difference and standardized mean difference data comparing oral pressure therapy to baseline values as treatment for obstructive sleep apnea. Review of the individual studies’ outcomes does not clearly demonstrate whether select groups would most benefit from oral pressure therapy based on OSA severity (mild, moderate or severe); however, as summarized by Nigam et al. BOPT success rate varied in the range of 27-43% for mild OSA, 42-71% for moderate OSA, and 23-50% for severe OSA^. [1]. The first limitation in this meta-analysis is that the majority of the original work evaluating oral pressure therapy has been performed by a select few investigators using industry funded * Macario Camacho drcamachoent@yahoo.com

Nasal Dilators (Breathe Right Strips and NoZovent) for Snoring and OSA: A Systematic Review and Meta-Analysis

Objective. To systematically review the international literature for studies evaluating internal (NoZovent) and external (Breathe Right Strips) nasal dilators as treatment for obstructive sleep apnea (OSA). Study Design. Systematic review with meta-analysis. Methods. Four databases, including PubMed/MEDLINE, were searched through September 29, 2016. Results. One-hundred twelve studies were screened, fifty-eight studies were reviewed, and fourteen studies met criteria. In 147 patients, the apnea-hypopnea index (AHI) was reported, and there was an improvement from a mean ± standard deviation (M ± SD) of 28.7 ± 24.0 to 27.4 ± 23.3 events/hr, p value 0.64. There was no significant change in AHI, lowest oxygen saturation, or snoring index in OSA patients when using nasal dilators. However, a subanalysis demonstrated a slight reduction in apnea index (AI) with internal nasal dilators (decrease by 4.87 events/hr) versus minimal change for external nasal dilators (increase by 0.64 events/hr). Conclusion. Although nasal dilators have demonstrated improved nasal breathing, they have not shown improvement in obstructive sleep apnea outcomes, with the exception of mild improvement in apnea index when internal nasal dilators were used.

Author Self-Citation in the Otolaryngology Literature: A Pilot Study.

Objective To determine the prevalence of author self-citation in the field of otolaryngology. Study Design and Setting A retrospective review of bibliographic references in 5 otolaryngology journals. Subjects and Methods Five high-impact otolaryngology journals were reviewed over a 3-month period between January and March 2014 to identify the pattern of author self-citations. Data included study type, otolaryngology topic, authorship, total citations, author self-citations, and country of origin. Results Nearly two-thirds of articles contained at least 1 self-citation, with an average of 2.6 self-citations per article. Self-citations represented nearly 10% of total citations. Articles with at least 1 self-citation had more authors (5.8 vs 4.9, P < .01) and more citations (30.4 vs 22.2, P < .01) per article than did those without self-citations. There was no difference in self-citation practices between articles originating within the United States and abroad (P = .65). Last authors were the most frequent self-citers and were more likely than lead authors to cite themselves (P < .01). Original reports contained the highest percentage of self-citations per article as compared with reviews and case reports (P < .01). Conclusion Author self-citation in the otolaryngology literature is common and compares similarly to other medical specialties previously studied. Self-citation should not be considered inappropriate, as it is often done to expand on earlier research. Nevertheless, editors, researchers, and readers should be aware of this increasingly recognized phenomenon and its associated potential implications to the process of scientific inquiry.

Tympanoplasty Outcomes for Blast-Induced Perforations from Iraq and Afghanistan 2007-2012

Objective To describe characteristics of blast-induced tympanic membrane perforations that do not spontaneously heal, evaluate the outcomes of tympanoplasty techniques, and understand the factors associated with surgical success. Setting Two tertiary military health care institutions. Study Design Case series with chart review. Subjects and Methods This study reviewed the practice of 1 military neurotologist and included all tympanoplasties for combat blast-induced perforations from 2007 to 2012, which comprised a total of 55 patients. Surgical outcomes and associated perioperative factors were examined to include size, location, bilateral involvement, timing of surgery, and surgical technique. Results Fifty-five patients (68 ears) met inclusion criteria. Thirty-six (53%) were total or near-total perforations, and 51% of patients had bilateral perforations. The overall success rate was 77%. It was 82% for lateral grafts and 70% for medial grafts, but the difference between these was not statistically significant. Age was a significant factor, with a success rate of 56% for ages 25 to 34 years, compared with 90% for 20 to 24 and >34 years. Patients who had bilateral sequential tympanoplasties also had lower success rates than those who had only unilateral surgery (62% vs 87%, P = .002). Ossicular disruptions were found in 5 ears, and cholesteatoma was discovered in 8. Surgical timing did not predict success, as the average time until repair was 153 days in successful cases and 151 days in failures. The mean conductive hearing improvement was 13.6 dB, and there were no major complications. Conclusion Tympanoplasty can be challenging in this population. Age and bilateral surgery were the only independent variables that showed significance.