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Quality of life consequences of
sleep-disordered breathing.
Flemons WW, Tsai W.
Department of Medicine, University of Calgary, Alberta, Canada.
Sleep-disordered
breathing occurs in approximately 2% to 4% of the adult population and
includes conditions in which patients stop breathing completely (apnea)
or have marked reductions in airflow (hypopnea) during sleep. Typical
symptoms of sleep apnea include snoring, restless sleep, excessive
daytime somnolence, nocturnal enuresis, irritability, depression,
memory deficits, inability to concentrate, and decreased alertness. The
clinically relevant outcomes of these symptoms include impairment in
work efficiency, increased automobile accident rates, and decrements in
quality of life. Treatment of sleep apnea, primarily with continuous
positive airway pressure, reduces sleepiness and improves mood
disturbances, neurocognition, and performance. Traditional measurements
of sleep apnea severity do not correlate well with current tests and
scales that are used to quantify alterations in alertness, performance,
quality of life, or sleepiness. A disease-specific quality of life
scale has been developed following patient and physician interviews and
literature reviews. The Calgary Sleep Apnea Quality of Life Index is
expected to capture aspects of quality of life important to sleep apnea
patients, such as cognitive function, performance, and mood, that could
be improved with appropriate treatment of sleep-disordered breathing.
Stop Snoring Solutions
Snoring, and some obstructive sleep apnea,
can be cured by oropharyngeal surgery.
Simmons FB, Guilleminault C, Silvestri R.
Surgical
resection of physiologically unneeded palate and oropharyngeal tissue
can completely stop a large part of social snoring problems and benefit
at least 50% of persons with the obstructive sleep apnea syndrome. We
report detailed results of the conditions of 28 patients who underwent
50 palatopharyn-goplasty (PPD) operations done by us since the concept
was introduced two years ago. The results clearly prove that the social
snoring problem of most patients can be fixed. The results are
inconclusive as to just how PPP surgery fits into predictive management
of sleep apnea. For some patients it is an effective alternative to
tracheotomy.
Snoring Solution
Snoring / sleep apnea-the success of surgery
Hormann K, Maurer JT, Baisch A.
Universitats-HNO-Klinik Mannheim, karl.hoermann@hno.ma.uni-heidelberg.de
INTRODUCTION.
Obstructive sleep apnea (OSA) is characterized by nocturnal collapsing
of the upper airways. Nasal continuous positive airway pressure (nCPAP)
ventilation is the gold standard in the treatment of obstructive sleep
apnea syndrome (OSAS). Long-term compliance rates do not exceed more
than 60 to 70%. Alternative multi-level surgeries are of interest,
combining procedures at the level of the base of tongue and the soft
palate in order to stabilize the airway. Preliminary results suggested
the hyoid suspension as one part of the multi-level surgery concept to
be of high effectiveness. Therefore this study investigated the outcome
of the hyoid suspension and compared it with the CPAP therapy. METHODS.
Between March 2001 and February 2003, 66 patients with OSA were treated
with a hyoid suspension in combination with surgeries at the base of
tongue, the soft palate or the nose (always performed by the same
surgeon). All patients underwent a pre- and postoperative
polysomnography in the sleep lab. Daytime sleepiness was assessed using
the Epworth Sleepiness Scale (ESS). Mean age was 52,1 years, the mean
body mass index (BMI) was 28,04 kg/m(2). RESULTS. The mean
apnea-hypopnea-index (AHI) was 38,9121,10/h before operation and
19,25+/-19,64/h after operation (p<0,0001). More statistically
significant changes were found for the arousalindex, the oxygen
saturation and the ESS (p<0,05). After surgery 57,6% of the subjects
(38/66) were regarded as cured (reduction of AHI >/=50% and below
15/h). Another 21,2% (14/66) improved (reduction of AHI >20%).
Altogether 78,8% of the patients were counted as responders.
CONCLUSION. Multi-level surgeries based on the hyoid suspension show
the effectiveness of this concept. This surgical strategy could be
equal to the CPAP mask, especially in cases of CPAP intolerance.
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