Laser-assisted uvulopalatoplasty in the
management of snoring and obstructive sleep apnea syndrome.
Han S, Kern RC.
Department of Otolaryngology-Head and Neck Surgery, Northwestern
University, Feinberg School of Medicine, Chicago, IL, USA.
Laser-assisted
uvulopalatoplasty (LAUP) was initially proposed as an alternative
method to treat habitual snoring. Throughout the years the indications
for LAUP have broadened, however, it has also remained an area of
controversy. LAUP is a staged office-based procedure involving removal
of excessive uvular mucosa and creation of transpalatal vertical
troughs to effectively widen the retropalatal airway. Since postlaser
treatment mimics the palatal appearance after uvulopalatopharyngoplasty
(UPPP), similar surgical outcomes can be expected in properly selected
patients. Although still an area of controversy, the medical literature
has supported the cost effectiveness, safety, and comparable efficacy
to the standard of UPPP in the treatment of snoring and obstructive
sleep apnea syndrome (OSAS). In select patients, LAUP is a viable
option for the management of not only snoring, but also OSAS.
Stop Snoring Solution Products
Soft palate implants: a new option for
treating habitual snoring.
Kuhnel TS, Hein G, Hohenhorst W, Maurer JT.
Department of Otorhinolaryngology, University of Regensburg,
Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Germany.
One
hundred six patients with proven habitual snoring were each treated
with three implants consisting of a cylindrical-shaped segment of
braided polyester filaments (18 mm in length with an outer diameter of
1.5 mm) in the soft palate. The implants, pre-loaded in a single-use
delivery tool, were inserted into the soft palate under local
anesthesia. Along with the initial examination, follow-up exams were
done after the treatment to test the safety and efficacy of the
procedure. Snoring post treatment was reported as "no snoring" or
"slight/occasional" in the majority of the cases after treatment. The
results indicate there were no serious adverse events reported. The
most frequent minor adverse events were partial extrusions in which the
patient often presented a minor foreign body sensation along with mild
transient pain. This data has demonstrated the procedure as a minimally
invasive, relatively painless, simple procedure that has been shown to
be safe and effective.
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Clinical prediction of the sleep apnea
syndrome.
Ward Flemons W, McNicholas WT.
Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Polysomnography,
the standard diagnostic test for people suspected of having sleep
apnea, is a limited resource due to its expense. Decisions about which
patients to refer to a sleep center and which require polysomnography
can be made based on an estimate of the probability that they have
sleep apnea. Clinical features that are associated with the severity of
sleep apnea, as judged by the apnea-hypopnea index, can be combined
together using statistical modeling into a clinical prediction rule,
whose diagnostic performance can be summarized by its sensitivity and
specificity or by likelihood ratios. To date, at least seven different
sleep apnea clinical prediction rules have been developed, most
incorporate anthropomorphic variables such as the body mass index,
waist circumference, and/or neck circumference, and some type of
abnormal respiration during sleep (snoring, apneas, choking and/or
gasping) witnessed by a bed partner. In general these rules have
reasonably high sensitivities but only intermediate specificities, thus
they can be useful in excluding the diagnosis but do not usually raise
the probability of sleep apnea high enough to warrant initiating
therapy without at least some type of additional testing to confirm the
diagnosis. In isolation the apnea-hypopnea index is not an optimal
indicator of disease severity, thus ultimately clinical decisions about
the need for polysomnography and/or the need for treatment must take
into account other important clinical information such as symptom
severity, quality of life, and the presence or absence of comorbid
illness.
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