Cases reported "Sleep Apnea, Obstructive"

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1/162. The use of ENT-prescribed home sleep studies for patients with suspected obstructive sleep apnea.

    Sleep disordered breathing, including obstructive sleep apnea, is a common and morbid health problem. Traditionally, sleep disordered breathing is diagnosed by complex sleep studies. However, newer, easy-to-use, highly sensitive, and highly specific home sleep study equipment is now available. The present study was undertaken to determine whether an otolaryngologist could easily and effectively dispense home sleep equipment from the office. We used a portable AutoSet home sleep machine. Our experience with the first 100 consecutively presenting patients was recorded and analyzed under institutional review board approval. Ninety-nine of the 100 tests were completed successfully on the first attempt; the one failure was successful on the second attempt. Our results were consistent with those reported from in-house polysomnogram sleep studies; 71% of our patients had an apnea-hypopnea index (AHI) of 15 or higher, and 93% had an AHI at least 5. We conclude that an otolaryngologist, using state-of-the-art home sleep testing equipment, can accurately and cost-effectively prescribe home sleep studies. ( info)

2/162. Transtracheal air in the treatment of obstructive sleep apnoea hypopnoea syndrome.

    A 49 year old woman with typical obstructive sleep apnoea hypopnoea syndrome underwent an unsuccessful trial with continuous positive airway pressure (CPAP) followed by uvulopalatopharyngoplasty with septorhinoplasty, treatment with protriptyline, and a second CPAP trial that was abandoned. Transtracheal air was then given and normalised sleep and breathing at a flow rate of 5 l/min. A sustained clinical improvement was observed at follow up visits. Transtracheal air could represent a simple and effective alternative to tracheotomy in patients with obstructive sleep apnoea hypopnoea syndrome in whom conventional treatments fail. ( info)

3/162. An unreported risk in the use of home nasal continuous positive airway pressure and home nasal ventilation in children: mid-face hypoplasia.

    We report the case of a 15-year-old boy with obstructive sleep apnea and obesity who was treated since the age of 5 with nasal continuous positive airway pressure. Due to the long-term use of a nasal mask, the child developed a mid-face hypoplasia. Chronic use of a nasal mask for home ventilation in children should always be associated with regular evaluations of maxillomandibular growth. ( info)

4/162. Pyknodysostosis: a report of two siblings with unusual manifestations.

    We report pyknodysostosis presenting as extramedullary haematopoiesis in one of two siblings and as obstructive airway disease in the other. Visceral manifestations are rare and have been reported in only two cases in the Indian literature. They have often been mistaken for osteopetrosis, haemolytic anaemia and other osteochondrodystrophies. The cases we report illustrate that, though the physical characteristics may be similar, it is the radiological features that are typical and help establish the diagnosis. ( info)

5/162. Obstructive sleep apnea in a growing patient.

    Sleep apnea syndrome (SAS) is a complex respiratory disorder that is very difficult to diagnose and to treat surgically as well as medically. SAS can affect growing patients as well as adults. SAS shows a central, an obstructive, and a mixed form. diagnosis is based on clinical examination of the patient and instrumental examinations such as teleradiography, nuclear magnetic resonance imaging (NMR), three-dimensional computed tomography, polysomnography, rhinomanometry, and spirometry. The patient presented has an obstructive form of SAS in addition to Crouzon's disease. He underwent a Le Fort III osteotomy to obtain an advancement of the orbitomaxillary complex, allowing an increase in volume of posterior airway space at the level of the hypopharynx. ( info)

6/162. sleep disorders in children and teens. Helping patients and their families get some rest.

    Diagnosing sleep disorders in children and adolescents is challenging and rewarding and requires integration of medical, neurodevelopmental, and behavioral histories. Most patients can be successfully treated once a thorough evaluation has been completed and age-appropriate differential diagnosis of common sleep disorders has been considered. With appropriate knowledge and tools, physicians may find that pediatric sleep disorders are some of the most treatable problems in medicine. ( info)

7/162. A case of squamous papilloma after uvulopalatopharyngoplasty.

    We report the case of an adult who developed an isolated-solitary papilloma on the margin of the soft palate 1 month after he had undergone a uvulopalatopharyngoplasty. We describe the clinical and cellular characteristics of this common lesion. ( info)

8/162. Bivalved palatal transposition flaps for the correction of acquired nasopharyngeal stenosis.

    Nasopharyngeal stenosis is almost universally an iatrogenic problem resulting from surgical trauma after adenotonsillectomy or uvulopalatopharyngoplasty (UPPP). In addition, laser-assisted uvulopalatopharyngoplasty for the treatment of snoring may lead to the development of cicatricial scarring and stenosis at the level of the velopharynx. The most common mechanisms implicated in the development of acquired nasopharyngeal stenosis are the overzealous removal of inferolateral adenoid tissue and excessive excision of the palatopharyngeal arches. Symptoms generally relate to a disturbance in respiration, olfaction, voice quality, and deglutition, and are often poorly tolerated. Surgical options for the correction of this challenging problem include steroid injections, scar lysis, skin grafts, Z-plasty repair, and the use of various local mucosal flaps. We report the successful use of bivalved palatal transposition flaps performed through the transoral route for the correction of severe acquired nasopharyngeal stenosis following UPPP in two patients. Both patients developed delayed nasopharyngeal stenosis following their initial surgery and subsequently failed several attempts at surgical correction of the stenosis, including laser lysis of the scarred soft palate. Using this technique of repair, both patients achieved satisfactory resolution of their symptoms, including comfortable nasal breathing and normal speech. We have found that this is a simple and effective technique for the correction of severe nasopharyngeal stenosis. ( info)

9/162. Upper airway resistance syndrome--report of three cases.

    INTRODUCTION: patients with the upper airway resistance syndrome are frequently overlooked, and even if clinically suspected, often escape identification by polysomnographic monitoring. CLINICAL PICTURE: Three cases (2 women and a man) with excessive daytime sleepiness and fatigue were confirmed to have the upper airway resistance syndrome after undergoing polysomnography with oesophageal pressure monitoring. TREATMENT: Nasal CPAP during sleep was prescribed for 2 cases but 1 case refused all available treatment options. OUTCOME: After one month of CPAP therapy, the 2 cases reported improved symptoms and Epworth sleepiness scores. Lower daytime blood pressures were also recorded. CONCLUSIONS: Oesophageal pressure monitoring and EEG arousal analysis can greatly enhance the diagnostic accuracy in the upper airway resistance syndrome. Accurate diagnosis and effective treatment of this condition is important because of its sequelae of hypersomnolence and association with other disorders like systemic hypertension. ( info)

10/162. Elongated uvula with a pleomorphic adenoma: a rare cause of obstructive sleep apnea syndrome.

    The authors encountered a case of elongated uvula with a pleomorphic adenoma originating from the minor salivary gland, causing frequent upper airway obstruction. A 75-year-old woman had obstructive sleep apnea syndrome brought about by the swallowing impact of the pendulous tumor into the hypopharyngeal and supralaryngeal spaces. Although there are some case reports about tumors originating from the uvula, this is the first reported to cause obstructive sleep apnea syndrome. ( info)
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