Cases reported "Sleep Apnea, Obstructive"

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1/38. 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.
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2/38. 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.
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3/38. 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.
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keywords = breathing, respiration
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4/38. Chiari malformation and sleep-disordered breathing: a review of diagnostic and management issues.

    Chiari Malformation (CM) encompasses several patterns of congenital or acquired cerebellar herniation through the foramen magnum. This may result in brain-stem compression that impacts control of breathing and is associated with obstructive and central apneas. A high clinical suspicion for sleep-disordered breathing is needed in the care of such patients after as well as before corrective surgery. To introduce a review of CM with a focus on the relevance to sleep medicine, we present a case of a 13-year-old female who was diagnosed with CM Type 1 in the course of an evaluation of symptomatic central sleep apnea. After initial improvement following surgery there was recurrence of brain-stem compression. The only clinical expression of which was polysomnographically evident recurrence of sleep apnea.
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5/38. sleep apnoea and Turner's syndrome.

    A 32-yr-old female with Turner's syndrome and anatomical craniofacial abnormalities, presented with obstructive sleep apnoea syndrome. This was initially treated by nasal continuous positive airway pressure and secondarily cured by maxillomandibullar advancement osteotomy. Anatomical upper airway abnormalities and hormonal factors, which predispose Turner patients to develop obstructive sleep apnoea syndrome, are discussed. A systematic assessment and treatment of sleep-disordered breathing is probably of interest in these patients.
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6/38. Orolaryngeal sarcoidosis presenting as obstructive sleep apnoea.

    A 53-year-old man was evaluated for snoring, dysphagia for solid foods and difficulty of breathing and a polysomnographic recording was consistent with a diagnosis of obstructive sleep apnoea syndrome (OSAS). A flexible fiberoptic bronchoscopy (FFB) showed the presence of a nodular lesion of the posterior ventral surface of the tongue strictly connected to the left lateral border of the epiglottis. The biopsy specimen taken from the lesion was consistent with sarcoidosis. No involvement of pulmonary parenchyma, lymph nodes or other organs was recognized. After two months of steroid treatment, symptoms disappeared and resolution of the nodular lesion at the FFB and normalization of the polysomnographic recording were observed. This is the first report of orolaryngeal sarcoidosis associated with OSAS as the only clinical presentation of the disease.
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7/38. amyotrophic lateral sclerosis associated with insomnia and the aggravation of sleep-disordered breathing.

    A case of amyotrophic lateral sclerosis (ALS) diagnosed by sleep-disordered breathing is described. The patient's chief complaints were insomnia and nocturnal dyspnea after taking a hypnotic drug. On examination, he showed restrictive ventilatory impairment, alveolar hypoventilation and hypoxia. Polysomnographic examination revealed marked hypoxia during REM sleep periods, decreased duration of REM sleep periods, and increased sleep disruption. amyotrophic lateral sclerosis was diagnosed by the neurological finding of paraspinal muscle weakness and neurogenic changes revealed by needle electromyography and muscle biopsy. The daytime and nocturnal respiratory insufficiency improved after nasal bilevel positive airway pressure therapy. amyotrophic lateral sclerosis should be suspected as a cause of insomnia and nocturnal dyspnea.
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8/38. Obstructive sleep apnea syndrome in a patient with medulloblastoma.

    We present one adult patient with medulloblastoma who developed polysomnographically documented obstructive sleep apnea after posterior fossa surgery. The sleep apnea worsened in conjunction with clinical and imaging-confirmed neoplastic progression and clinically improved after craniospinal radiation therapy. medulloblastoma or its surgical treatment has never before been implicated in a sleep-related breathing disorder. We discuss possible mechanisms for its occurrence and management implications.
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keywords = breathing
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9/38. Complications of radiofrequency ablation in the treatment of sleep-disordered breathing.

    OBJECTIVE: To evaluate complications of radiofrequency ablation (RFA) in the treatment of sleep-disordered breathing and to outline complication avoidance strategies. STUDY DESIGN AND SETTING: Retrospective review of 51 consecutive RFA treatment sessions for SDB to the soft palate and tongue base by a single surgeon at a tertiary medical center. RESULTS: Over 2 years, 51 treatments comprising 26 palatal and 25 tongue base RFA treatments were performed for sleep-disordered breathing on 30 patients. Complications included palatal mucosal breakdown (11 cases), temporary tongue base neuralgias (4 cases), uvular sloughing (2 cases), tongue base abscesses (2 cases), and floor of mouth edema with airway compromise (2 cases). CONCLUSIONS/SIGNIFICANCE: This is the first paper focusing on complications of RFA. While complications from soft palate RFA present rapidly and are self-limiting, complications from tongue base RFA may be delayed and life threatening. A detailed strategy is provided to avoid and treat these complications.
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10/38. Obstructive sleep apnea is a false-negative cause of flow velocity paradoxus in pericardial effusion: case report.

    We report on a patient with obstructive sleep apnea in whom percutaneous transmyocardial revascularization was complicated by hemopericardium. Absence of phasic variation in the transmitral and transtricuspid Doppler inflow velocities during apneic episodes and marked variation during spontaneous respiration were identified with a respirometer, and helped us identify a novel false-negative cause of flow velocity paradoxus.
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keywords = respiration
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