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Objectives: This study aimed to devise a modified oximetry scoring system and calculate its diagnostic accuracy in detecting paediatric obstructive sleep apnoea syndrome (OSAS). Study Design: This prospective diagnostic accuracy study was divided into two phases. Setting: The study was conducted at a quaternary teaching hospital. Methods: Polysomnograms performed from 1 April 2014 to 31 December 2021 were included. In Phase 1, the parameters of 95 oximetry trend graphs were evaluated, and a modified scoring system was constructed. In Phase 2, the modified scoring system was employed in 272 oximetry trend graphs, and its diagnostic accuracy was determined. A logistic regression model was used to assess the ability of each scoring system to predict paediatric OSAS. Results: A total of 367 patients were recruited. In Phase 1, a four‐tier severity classification system was constructed. In Phase 2, its diagnostic accuracy was found to be 53.3% sensitive, 97% specific, with positive predictive value of 98.5% and negative predictive value of 34.6%. The lowest detectable apnoea–hypopnoea index (AHI) was 4.5. The inter‐rater reliability calculated was 80%. Logistic regression was applied to assess associations of the modified McGill score (MMS) or McGill oximetry score (MOS) with OSAS. The area under the receiver operating characteristic curve was higher for the MMS than for MOS (0.78 [95% CI 0.73–0.84] vs. 0.59 [95% CI 0.51–0.66]). Conclusion: This study demonstrated that our modified scoring system had increased sensitivity at detecting OSAS at a much lower AHI and showed a much greater ability to predict paediatric OSAS. [ABSTRACT FROM AUTHOR]

Objectives: Minimally invasive, single‐staged multilevel surgery (MISS MLS) could be an optimal treatment for selected patients with obstructive sleep apnea (OSA). We aim to systematically review the efficacy of MISS MLS for patients with OSA, as well as the clinical outcomes and possible complications in OSA patients before and after MISS MLS. Design and setting: Systematic review and meta‐analysis. Six databases were searched, and the PRISMA guideline was followed. Participants: Patients with OSA receiving MISS MLS. Main outcome measures: The random‐effects model was adopted for the statistical synthesis. The percentage and 95% confidence interval (CI) were adopted as the effect measurements of MISS MLS for OSA. Subgroup analyses and sensitivity analyses were also performed to identify the heterogeneity among the studies. Results: There were initially 154 articles for identification. Eventually, six studies with a total of 848 OSA patients completely met the inclusion criteria and were further enrolled for analysis. The pooled analysis showed statistically significant lower AHI (apnea/hypopnea index, /hr.; mean difference: −8.931, 95% CI: −11.591 to −6.271, I2 = 87.4%), ESS (mean difference: −2.947, 95% CI: −4.465 to −1.429, I2 = 94.9%), and snoring severity with 0‐10 visual analog scale after surgery (mean difference: −4.966, 95% CI: −5.804 to −4.128, I2 = 96.4%). The success rate was 46% in mild/moderate OSA; however, 18% in severe OSA. There were no major complications occurred. Conclusions: The acceptable surgical outcomes, esp. in mild/moderate OSA, and rare complications are the major advantages of MISS MLS. The evidence of this study could aid the decision making in selecting suitable treatment programs for OSA patients. [ABSTRACT FROM AUTHOR]

Introduction: Recent guidelines suggest obstructive sleep apnoea (OSA) is not an absolute contraindication for same day discharge following surgery. The aim of this systematic review was to examine the feasibility and safety of day case nasal and/or palatopharyngeal surgery in patients with OSA. Methods: We performed a systematic search of PubMed, EMBASE and the Cochrane library. Quality assessment of included studies was performed. The protocol of this systematic review was registered with PROSPERO (CRD42021273451). Results: A total of 1836 patients from 10 observational studies were included. There were 268 (15.4%) nasal surgeries, 738 palatopharyngeal surgeries (42.4%) and 735 (42.2%) combined nasal and palatopharyngeal surgery. The majority of patients had moderate to severe OSA. A total of 860 patients (49.8%) were successfully discharged as day cases. There were no standard criteria for daycase surgery. Post‐anaesthetic respiratory events were reported in 86/1750 (4.9%) patients. Oxygen desaturation was the most common respiratory event (83.7%, n = 72). There was no mortality reported. Conclusion: Current data suggests day surgery is feasible in carefully selected patients with OSA undergoing nasal and/or palatopharyngeal surgery. Further well‐designed prospective studies with an emphasis on the systematic assessment of complications are required to establish safety and daycase criteria. [ABSTRACT FROM AUTHOR]

Objectives: Obstructive sleep apnoea (OSA) is a common indication for adenoidectomy and tonsillectomy in children. Traditional practice involves overnight admission to monitor for respiratory complications. However, there is a shift towards same‐day discharge in selected patients. This systematic review aims to critically evaluate day‐case criteria and safety in children with OSA undergoing adenotonsillectomy. Design: We performed a systematic search of EMBASE, Medline and the Cochrane library. All data collected were independently validated for accuracy. Quality assessment of included articles was performed. The protocol was registered with PROSPERO. Results: A total of 15 studies were included (10 731 patients). There was heterogeneity in methods used to ascertain OSA, day‐case discharge criteria and lack of prospective discharge protocol. The proportion of children considered for planned day‐case surgery ranged from 28.7%–100% based on individual criteria, with an average rate of successful same‐day discharge of 96.1% in these patients. The reported rates of post‐operative respiratory adverse events and need for airway intervention were 0%–27.3% and 0.4%–6.8%, respectively. There was no reported mortality. The studies were considered low to medium on quality assessment. Conclusion: There is a lack of prospective data on day‐case criteria and systematic assessment of post‐operative complications in children with OSA undergoing adenoidectomy and tonsillectomy. However, current literature suggests that day‐case surgery is safe in carefully selected patients. Better characterisation of patient‐specific risk factors is needed to develop an optimal criteria‐based timeline for safe discharge. This has the potential to improve confidence and uptake across units. [ABSTRACT FROM AUTHOR]

Age and significant comorbidities are key factors in determining post-operative complication risk following adenotonsillectomy in paediatric patients with obstructive sleep apnoea. Keywords: adenotonsillectomy; day case surgery; obstructive sleep apnoea EN adenotonsillectomy day case surgery obstructive sleep apnoea 181 186 6 12/27/21 20220101 NES 220101 Key Points Outcomes following adenotonsillectomy for paediatric obstructive sleep apnoea from our centre support the paediatric national safety strategy recommendations published in 2019. Two (2/281, 0.7%) patients who underwent intracapsular coblation adenotonsillectomy and three (3/217, 1.4%) patients who underwent extracapsular dissection adenotonsillectomy required a return to theatre for post-operative bleeding. [Extracted from the article]

Objectives: Intracapsular tonsillectomy (ICT) is increasingly adopted by paediatric centres worldwide due to its association with reduced pain, fast recovery and low risks of post‐operative complications. Questions still surround its role in patients with recurrent tonsillitis, as well as tonsillar regrowth requiring revision surgery. Design: Prospective consecutive case series from March 2013 to April 2020. Setting: Tertiary paediatric ENT referral centre. Participants: Paediatric patients undergoing Coblation ICT, with or without adenoidectomy, for obstructive and/or infective indications. Main outcome measures: Health‐Related Quality of Life (HRQL), analgesia requirement, post‐operative haemorrhage rates, time to return to normal diet and activity or school/nursery, and parental satisfaction. We report revision surgery rates and identify predictive factors for revision surgery. Results: A total of 1257 patients (median age 4.2 years) underwent Coblation ICT, with a median direct and implied follow‐up of 101.5 and 1419 days, respectively. We noted significantly improved HRQL scores across all domains. Median analgesia requirement was six days, and no patients required a return to theatre for post‐operative haemorrhage. The majority of patients were eating a normal diet within 24 hours and returned to normal activity/school within a week post‐operatively. Revision surgery was required in 2.6% of cases, mainly due to recurrent obstructive symptoms from tonsillar regrowth. Being under two years old at initial surgery (OR 5.10), having severe OSA (OR 4.43) or severe comorbidities (OR 2.98) increased the risk of needing revision surgery. Conclusions: Long‐term data demonstrate the efficacy and safety of Coblation ICT in paediatric patients across a range of indications. [ABSTRACT FROM AUTHOR]

Objective: To explore the effects of an enhanced recovery after surgery (ERAS) programme on postoperative rehabilitation in children with obstructive sleep apnoea (OSA) during the perioperative period of adenotonsillectomy. Design: A retrospective historical control study. Setting: Service improvement project. Participants: The study included 394 children with OSA (207 males, 187 females; age range, 2.5 years to 14 years) who underwent adenotonsillectomy. Main outcome measures: The children who had undergone adenoidal ablation and bilateral tonsillectomy were divided into an ERAS group (208 patients) treated with the combined optimisation measures and a control group (186 patients) treated with traditional measures during the perioperative period. The postoperative incidence of complications, pain scores, anxiety scores and postoperative diets in the two groups were assessed. Results: Patients in the ERAS group had significantly a lower overall complication rate and incidence of fever for 2 weeks of follow‐up when compared to patients in the control group through the application of perioperative optimisation measures. Furthermore, patients in the ERAS group had less post‐surgical pain, had better dietary intake at days 1, 3 and 7 after surgery and had lower preoperative anxiety scores after admission education and while waiting in the operation room. Conclusion: The ERAS programme consisting of combined optimisation measures can reduce physical and psychological trauma during the perioperative period of adenotonsillectomy performed for children with OSA. [ABSTRACT FROM AUTHOR]

Objectives: Given that 30%‐50% of children with trisomy 21 have persistent obstructive sleep apnoea (OSA) after adenotonsillectomy, we evaluated whether demographic, clinical and polysomnographic factors predicted persistent OSA and OSA severity after adenotonsillectomy. Design: Retrospective study. Setting: Secondary care hospital. Participants: Retrospective review of 32 children with the diagnosis of trisomy 21 and OSA by polysomnography who underwent adenotonsillectomy, from January 2010 to December 2018. Main outcome and measure: Non‐parametric analysis was used to compare pre‐ and postoperative factors, and regression was used to model persistent OSA and OSA severity. Results: Thirty‐two children were included (17 males, median age 10.00 ± 8.00 years, median body mass index z‐score 0.89 ± 1.25). Overall, adenotonsillectomy resulted in a significant improvement in median obstructive apnoea‐hypopnoea index (oAHI) from 7.5 ± 8.95 to 4.40 ± 4.38 events per hour (P <.001) and in median OSA‐18 score from 85.00 ± 12.00 to 61.00 ± 37.75 (P <.001). Persistent OSA was found in 56.25% of the children. Univariate regression suggests that postoperative OSA‐18 score was associated with persistent OSA after adenotonsillectomy. Preoperative oAHI, preoperative oxygen desaturation index, pre‐ and postoperative OSA‐18 scores correlated with OSA severity after adenotonsillectomy. However, in a multivariate model only the postoperative OSA‐18 score correlated with OSA severity after adenotonsillectomy. Conclusions: Although adenotonsillectomy results in a significant improvement of OSA in children with trisomy 21, more than half of the children had persistent OSA. The postoperative OSA‐18 score was associated both with persistent OSA and OSA severity after adenotonsillectomy. [ABSTRACT FROM AUTHOR]

Objectives: Awake nasopharyngoscopy is routinely performed in the assessment of patients who require treatment for sleep‐disordered breathing (SDB). However, the applicability and accuracy of Müller's manoeuvre, the main evaluation method for this purpose, are disputable. The current study aimed to introduce an alternative method for awake nasopharyngoscopy in patients with SDB. Design: We defined qualitative anatomical features during tidal breathing at the levels of the soft palate, oropharynx, tongue base, epiglottis and hypopharynx, and compared these awake features to the sites and patterns of collapse as observed during drug‐induced sleep endoscopy (DISE). Setting: Tertiary care academic centre. Participants: Seventy‐three patients diagnosed with SDB. Main outcome measures: The primary outcome measure was the Kendall's tau correlation coefficient (τ) between observations during awake nasopharyngoscopy and DISE. Kappa‐statistics (κ) were calculated to assess the agreement on awake endoscopic features with a second observer. Results: In contrast to epiglottis shape, the modified Cormack‐Lehane scale was significantly associated with epiglottis collapse during DISE (P <.0001; τ =.45). Other upper airway features that were correlated with DISE collapse were the position of the soft palate (P =.007; τ =.29), crowding of the oropharynx (P =.026; τ =.32) and a posteriorly located tongue base (P =.046; τ =.32). Interobserver agreement of endoscopic features during tidal breathing was moderate (0.60 ≤ κ < 0.80). Conclusion: The current study introduces a comprehensive and reliable assessment method for awake nasopharyngoscopy based on anatomical features that are compatible with DISE collapse patterns. [ABSTRACT FROM AUTHOR]

Background: Tonsillectomy is one of the most common surgical procedures in children but indications and surgical practice change over time. Objectives: We aimed to identify trends in tonsillectomy procedures in children, in particular the number of procedures performed, the age of child undergoing tonsillectomy and the type of hospital in which the surgery was performed. Design: Review of Scottish Morbidity Records data (SMR01) which are routinely collected after everyday case procedure or overnight stay in all Scottish NHS hospitals. Setting: All NHS hospitals in all 14 Scottish health boards. Participants: All children (0‐16 years) undergoing tonsillectomy, 2000‐2018. Main outcome measures: Number of tonsillectomy procedures; rate of tonsillectomy per 1000 children in the population; number of children aged 0‐2 years and 3‐4 years undergoing tonsillectomy; health board in which the surgery occurred; diagnostic coding for these episodes; length of stay and readmission within 30 days of surgery. Results: During 2000‐2018, there were 50,208 tonsillectomies performed in children in Scotland (mean 2642/year). The number of tonsillectomies per year remained constant (R = 0.322, P =.178) but tonsillectomies performed in children 0‐2 years rose from 0.41 to 1.56 per 1000 (R = 0.912, P <.001), and 3‐4 years from 3.06 to 6.93 per 1000 (R = 0.864, P <.001). The proportion of all children's tonsillectomies performed up to age 4 rose from 20.6% to 35.9% and up to age 2 from 2.4% to 8.1%. All specialist children's hospitals showed a significant increase in surgery in very young children. Conclusions: Tonsillectomy rates remained static between 2000 and 2018, despite a falling population. More tonsillectomies are now performed for obstructive sleep apnoea, at a young age and in regional children's hospitals. This has important implications for the workload of these specialist hospitals. [ABSTRACT FROM AUTHOR]

Objective: The neurocognitive associations in paediatric obstructive sleep apnoea (OSA) are well known; however, whether polysomnographic features can predict these associations is unknown. Therefore, the primary objective of this study was to compare common polysomnographic parameters in children with OSA in the presence and absence of neurocognitive dysfunction. Methods: Polysomnography data for children ages 3‐6 years with mild‐moderate OSA who as defined by AHI between 5 and 10 were analysed from a single sleep centre at a tertiary paediatric hospital from January 2016 to December 2018. The following parameters were identified: arousals per hour, percentage of time asleep, apnoea‐hypopnoea index (AHI), oxygen desaturation nadir during sleeps, baseline oxygen saturation during sleep, time spent with SpO2 less than 90%, maximum transcutaneous CO2, per cent of the total sleep time spent with TcCO2 greater than 50 mmHg, age, body mass index (BMI), gender and type of disability in the neurocognitive dysfunction group. Neurocognitive diagnoses were recorded. Those with syndromic comorbidities were excluded. The study cohort was then compared to a cohort of 200 subjects with OSA and no neurocognitive disorders matched for age, gender and BMI. A paired column analysis by chi‐squared analysis was then undertaken between the two groups. Results: A total of 200 children were identified (126 males and 74 females) in the neurocognitive dysfunction group (OSA with neurocognitive dysfunction) and compared with 200 children in the control group (OSA without neurocognitive dysfunction) (113 males and 87 females). There were no statistical differences between groups. Conclusion: Commonly used polysomnographic indices are not predictive of neurocognitive dysfunction in paediatric OSA. [ABSTRACT FROM AUTHOR]

Background: Obstructive sleep‐disordered breathing (OSDB) is very common in children. Adenotonsillectomy is usually curative, but there is emerging evidence that topical nasal steroids can also be effective for some children and may avoid the need for surgery. The number of children referred for assessment of OSDB is increasing and in some departments, waiting times are long. We established a paediatrician‐led clinic for assessment and initial medical management of OSDB and in this study we report the proportion of children who avoided the need for surgery. Method: Referral letters to the otolaryngology department were screened and those with suspected OSDB and no significant co‐morbidities were diverted to the paediatrician‐led clinic. We recorded data for a consecutive series of children seen in this clinic with suspected OSDB over a 3‐month period. Parents completed a 5‐item subset of questions from the OSA‐11 questionnaire before and after treatment with 6 weeks of topical nasal steroids. Results: In the 3‐month study period, 103 children were seen, with a mean age of 6 (range 1‐16). Six (5.8%) had improved spontaneously before clinic attendance. Of the 97 children who were still symptomatic, 17 (17.5%) were referred directly for surgery on the basis of the severity of their symptoms, or because of other coexisting conditions that required surgical treatment (such as recurrent tonsillitis or otitis media). Three declined intranasal steroids. Seventy‐seven had a trial of intranasal steroids, of whom 34 (35%) reported enough improvement to avoid surgery, and 29 (28%) failed to improve and were referred for surgery. Fourteen (14%) failed to attend after the trial of steroids: of these, 5 (5%) were contactable by phone and confirmed improvement after topical steroids. OSA‐5 scores were significantly improved following intranasal steroids. Discussion: A paediatrician‐led clinic can be an effective way to ease the workload of an over‐stretched otolaryngology service, and judicious use of topical nasal steroids can help around 40% of children with OSDB avoid surgery. [ABSTRACT FROM AUTHOR]

Background: Tonsils are first‐line host defence organs against pathogenic agents and participate in local and systemic immunity. Persistent increases in systemic inflammatory responses may contribute to associated morbidity. The aim of this study was to verify the short‐ and long‐term impact of adenotonsillectomy on the evolution of inflammatory markers in 3‐ to 9‐year‐old children. Methods: A prospective and longitudinal study was conducted over 1 year in 29 children who underwent tonsillectomy due to either chronic tonsillitis or adenotonsillar hypertrophy. Measurements of high‐sensitivity C‐reactive protein (hs‐CRP) levels were taken. Levels of Th1‐type cytokines [interleukin‐1, interferon‐γ, and tumor necrosis factor‐α (TNF‐α)] and anti‐inflammatory Th2‐type cytokines [interleukin‐4, ‐5, ‐6, ‐10 and ‐13] were measured. Levels of transforming growth factor‐beta (TGF‐β) and intercellular adhesion molecule‐1 (ICAM‐1) were also determined. The results were compared to those of 29 control children. Results: At baseline, children with surgery indications presented with higher levels of hs‐CRP, interleukin‐1 and ‐10, interferon‐γ, TNF‐α and ICAM‐1, whereas values of interleukin‐4 were significantly lower than in control children. Children with severe tonsillar obstruction had higher values of interleukin‐1, ‐4, and ‐5 and lower values of interleukin‐10 compared with children with recurrent tonsillitis. One year after surgery, the levels except IL‐4 did not show a significant difference from those obtained in the control group. The levels of hs‐CRP and TNF‐α decreased significantly in the first month. Conclusion: Children with chronic tonsillitis and/or adenotonsillar hypertrophy have significantly elevated levels of proinflammatory cytokines. Adenotonsillectomy restores the normal values of these parameters 1 year after surgery. [ABSTRACT FROM AUTHOR]

Objective: Various anatomical structures of upper airway and physical differences are known to be risk factors for obstructive sleep apnoea (OSA). Torus mandibularis is a structure that can appear on the inside of the mandible. Therefore, it is possible for tori to influence airway volume by occupying the space for tongue and cause sleep apnoea. The purpose of this study is to investigate the effect of torus mandibularis on the severity of OSA as one of the craniofacial risk factors. Design: Retrospective case‐control study. Setting: University‐based tertiary medical centre. Participants: Adult patients over 19‐years‐old who visited outpatient clinics with complaints of sleep‐disordered breathing symptoms between January 2010 and December 2017 were investigated. Main outcome measures: The presence of torus mandibularis in oral cavity was confirmed by physical examination or CT image. We analysed demographic findings including age, sex, medical history, previous operation history, physical findings of upper airway and result of polysomnography. To evaluate the effect of torus mandibularis on OSA, polysomnography data of the two groups according to presence or absence of torus mandibularis were compared and analysed. Results: Two‐hundred and thirty‐two OSA patients with BMI <25 were divided into two groups, according to either the presence or absence of torus mandibularis. We analysed 138 patients of control group and 94 of torus mandibularis group. Apnoea‐hypopnoea index (AHI) was 18.8 ± 14.9 in control group and 25.1 ± 18.4 in torus mandibularis group (P = 0.006). Respiratory disturbance index (RDI) was 23.1 ± 14.7 in control group and 27.9 ± 18.4 in torus mandibularis group (P = 0.035). Supine AHI showed 26.6 ± 20.3 in control group and 32.5 ± 22.6 in torus mandibularis group (P = 0.039). Patients with torus mandibularis had a trend of increase in proportion according to the severity of sleep apnoea, such as AHI (P = 0.007) or RDI (P = 0.034). Conclusions: We newly found that the presence of torus mandibularis affects not only severity of OSA and also position‐dependent OSA. These results support the necessity of torus mandibularis evaluation in OSA patients, and further study is also required to investigate its consequence in the surgical outcome. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship between baseline snoring sound energy (SSE) and disease severity, changes in SSE after adenotonsillectomy, and the predictors of surgical success in children with obstructive sleep apnoea (OSA). Design: Prospective cohort study. Setting: Tertiary referral medical centre. Participants: Thirty‐two children with OSA whose apnoea‐hypopnoea index ≥5 or apnoea‐hypopnoea index ≥1.5 with OSA comorbidities were recruited. Patients with complicated OSA were excluded. All participants underwent snoring sound analysis, polysomnography, and adenotonsillectomy. Main outcome measures: Snoring sound energy and apnoea‐hypopnoea index were assessed at baseline and 6 months after adenotonsillectomy. Surgical success was defined as a postoperative apnoea‐hypopnoea index <1.5. Results: The median age, body mass index, and apnoea‐hypopnoea index was 9 years, 19.0 kg/m2, and 13.2 events/h, respectively. Multivariate logistic regression showed that a baseline tonsil size of IV (odds ratio 15.7 [95% CI: 1.5‐166.3]) and SSE of 801‐1000 Hz > 21.9 dB (odds ratio 32.3 [95% CI: 2.6‐396.6]) were significantly related to severe OSA. Following adenotonsillectomy, apnoea‐hypopnoea index decreased significantly (P < 0.001). SSE of 41‐200 Hz, 201‐400 Hz and 801‐1000 Hz also decreased significantly (P = 0.04, 0.01 and 0.006, respectively). Baseline SSE of 801‐1000 Hz < 8.5 dB significantly predicted surgical success (odds ratio 11.0 [95% CI: 1.4‐85.2]). Conclusions: Our findings suggest the potential utility of SSE of 801‐1000 Hz to screen for severe OSA, predict surgical success and assess therapeutic outcomes. Specific baseline SSE may represent a potential biomarker for childhood OSA. [ABSTRACT FROM AUTHOR]

The article presents the study that investigates the effectiveness of hypoglossal nerve stimulator (HNS) implantation in treating moderate to severe obstructive sleep apnoea (OSA) in Cleveland, Ohio. The topics discussed include the causes of OSA, the approval given by the government agency the U.S. Food and Drug Administration on HNS and the result of the randomized controlled trial of patients who underwent HNS.

Background: The first edition of the European position paper (EPP) on drug‐induced sleep endoscopy (DISE) was published in 2014 with the aim to standardise the procedure, to provide an in‐depth insight into the main aspects of this technique and to have a basis for future research. Since 2014, new studies have been published concerning new sedative agents or new insights into the pattern/levels of the obstruction depending on the depth of sedation. Therefore, an enlarged group of European experts in the field of sleep breathing disorders (SBD), including the most of the first DISE EPP main authors, has decided to publish an update of the European position paper on DISE, in order to include new evidence and to find a common language useful for reporting the findings of this endoscopic evaluation in adult population affected by SBD. Methods: The authors have evaluated all the available evidence reported in the literature and have compared experience among various departments in leading European centres in order to provide an update regarding the standardisation of the DISE procedure and an in‐depth insight into the main aspects of this technique. Results: After the first European Position Consensus Meeting on DISE and its update, consensus was confirmed for indications, required preliminary examinations, where to perform DISE, technical equipment required, staffing, local anaesthesia, nasal decongestion, other medications, patient positioning, basics and special diagnostic manoeuvres, drugs and observation windows. So far, no consensus could be reached on a scoring and classification system. However, regarding this aim, the idea of an essential classification, such as VOTE with the possibility of its graded implementation of information and descriptions, seems to be the best way to reach a universal consensus on DISE classification at this stage. A common DISE language is mandatory, and attempts to come to a generally accepted system should be pursued. [ABSTRACT FROM AUTHOR]

Objective: To validate the use of Cormack‐Lehane and Modified Cormack‐Lehane scoring systems to classify patterns of hypopharyngeal airway visualization seen during awake flexible laryngoscopy among patients with obstructive sleep apnoea. Study design: Validation study using samples collected from a prospective database. Setting: University Medical Center. Participants: Data were obtained from a retrospective review of a prospective database of flexible fiberoptic examination recordings in 274 consecutive OSA subjects (Stanford Sleep Medicine/Surgery Clinic). Main outcome measures: Single still images from awake fiberoptic laryngoscopy examinations of the vocal cords from 90 different patients were presented to 2 experts and 4 novice raters. Raters used two grading systems (Cormack‐Lehane scale and Modified Cormack‐Lehane) to rate vocal cord visualization. Percent agreement and Cohen's kappa statistical analysis were used to evaluate inter‐rater reliability and intrarater reliability for each grading system. Feedback from the participants was then used to propose updates to further improve upon the existing grading scales for their applicability to awake flexible endoscopy. Results: The Cormack‐Lehane and Modified Cormack‐Lehane scale both communicate unobstructed and restricted views of the vocal cords reliably. Compared to the 4‐grade scale, however, a modified 5‐grade Vocal Cord Grading System allows for better objective communication of common variations in hypopharyngeal airway visualization. Conclusion: We propose a 5‐Grade Vocal Cord Grading System that builds upon existing grading systems to allow for efficient and reliable communication of hypopharyngeal airway examination during awake fiberoptic laryngoscopy. [ABSTRACT FROM AUTHOR]

Objectives: To compare the results of tissue preservation techniques of soft palate surgeries including expansion sphincter pharyngoplasty (ESP) and barbed reposition pharyngoplasty (BRP) for patients suffering from obstructive sleep apnoea (OSA) with the traditional uvulopalatopharyngoplasty (UPPP). Design: Interventional comparative study. Setting: Morgagni‐Pierantoni Hospital. Participants: Seventy‐five patients were included in the study, divided into three groups with 25 patients per group: UPPP, ESP or BRP. Main outcomes measures: Polysomnography was carried out for all patients pre‐ and postoperatively; the postoperative results were recorded at least 6 months after surgery. All patients were assessed preoperatively using drug‐induced sleep endoscopy. Epworth Sleepiness Scale and body mass index (BMI) were registered for all patients before and after surgery. Results: The mean of pre‐ and postoperative differences of apnoea‐hypopnoea index values was higher in BRP group than ESP: 15.76 ± 14.5 Vs 10.13 ± 5.3; P < .05 and UPPP groups: 15.76 ± 14.5 vs 6.08 ± 5.5; P < .0005. The mean of differences of oxygen desaturation index values was higher in BRP group than UPPP group: 15.09 ± 17.6 vs 7.13 ± 6.8; P < .0005, but not significantly higher than ESP group: 15.09 ± 17.6 vs 6.48 ± 7.9; P > .05. The mean of differences of ESS values was higher in BRP group than ESP group: 5.52 ± 4.1 vs 4.84 ± 3.3; P < .005 and UPPP groups: 5.52 ± 4.1 vs 1.36 ± 1.9; P < .005. Finally, the pre‐ and postoperative means of differences of lowest oxygen saturation values were not statistically significant among the three groups (P > .05). Conclusion: Barbed reposition pharyngoplasty (BRP) can be considered an effective procedure on the basis of the postoperative outcomes. ESP still proves to be a good technique especially when performed by experienced surgeons. Both techniques proved to be superior to UPPP. [ABSTRACT FROM AUTHOR]

Objectives: To compare the efficacy and safety of transoral robotic surgery (TORS) with endoscope‐guided coblation tongue base resection. Design: Retrospective case‐control study. Setting: University‐based tertiary care medical center. Participants: Patients with obstructive sleep apnoea (OSA) who underwent endoscope‐guided tongue base coblation resection or transoral robotic surgery (TORS) in combination with lateral pharyngoplasty at a single institution in South Korea between April 2013 and December 2016 were investigated. Forty‐five patients who had moderate‐to‐severe OSA with tongue base collapse and a minimum follow‐up period of 6 months with postoperative polysomnography (PSG) were enrolled in this study. Main outcome measures: All patients underwent pre‐ and postoperative (at least 4 months after surgery) overnight PSG. Available information on results of the PSG, Epworth sleepiness scale and complications of the TORS and coblation groups were compared. Results: Postoperative PSG studies showed improved sleep quality for most patients. The mean postoperative apnoea‐hypopnea index (AHI) was reduced significantly from 45.0 to 17.0 events/h (P < .0001) in the TORS group and from 45.6 to 16.2 events/h (P < .0001) in the coblation group. The mean rates of improvement (AHI reduction > 50%) were 75.0% in TORS patients and 62.1% in coblation patients and the difference was not significant. Less frequent postoperative morbidity, including bleeding, taste dysfunction and foreign body sensation, was recorded in TORS patients. Conclusions: Both the coblation and TORS groups showed similar surgical outcomes, TORS achieved PSG results non‐inferior to and complication rates comparable to coblation. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the prevalence of obstructive sleep apnoea syndrome (OSAS) in a population of patients treated for an advanced oropharyngeal cancer (AJCC Stage III or IV), depending on treatment strategy, and to evaluate its impact on quality of life. Design Prospective cohort study. Setting University Teaching Hospital of La Conception, Marseille, France. Participants Fifty-one disease-free patients were included. Forty-one patients received a combined chemoradiotherapy, while 10 patients were treated by surgery followed by chemoradiotherapy. Main Outcome Measures Every patient underwent a formal sleep consultation and was asked to complete the Epworth Sleepiness Scale and EORTC QLQ C-30 and the EORTC H&N 35 questionnaires. A home overnight respiratory polygraphy was performed in every subject. Results The mean time between the end of cancer treatment and the OSAS analysis was 54.04 months [20; 84]. An OSAS was found in 25.49% of our patients. There was no significant difference between patients treated with either surgery (30%) or CRT (24.39%), P=.79. The EORTC QLQ C-30 questionnaire showed a significant difference between positive and negative OSAS groups in the Global Health Status Scale (50.64 vs 67.11, P=.02) and in the fatigue item (35.04 vs 17.25, P=.03). Conclusions Our population with advanced oropharyngeal cancer, whatever the treatment strategy it may be, was at risk of developing OSAS with negative impact on quality of life. A routine screening and treatment of OSAS seems necessary to improve the quality of life of patients treated for advanced oropharyngeal cancer. [ABSTRACT FROM AUTHOR]

Objectives The primary objective of the study was to understand the differential impact of continuous positive airway pressure ( CPAP) on the location, degree and pattern of airway collapse in obstructive sleep apnea ( OSA) patients utilizing drug-induced sleep endoscopy ( DISE). Study design Non-randomized trial. Setting University Medical Center. Participants Fifteen consecutive OSA patients undergoing DISE. Main outcomes and measures The patterns of airway collapse were videorecorded at baseline and under differential application of nasal CPAP ( nCPAP) at 5, 10 and 15 cm H2O. For each modality, the pattern and degree of airway collapse were analyzed by three independent observers using the velum, oropharynx, tongue base, epiglottis ( VOTE) classification system. Results The modest nCPAP pressures (10 cm H2O) had the greatest impact on the lateral walls of the pharynx, followed by the palatal region. The collapsibility of the tongue base and epiglottis demonstrated significant resistance to nCPAP application, which was overcome by increasing nCPAP to 15 cm H2O. Compared to 5 cm H2O, nCPAP pressures of 10 and 15 cm H2O improved complete collapse at least at one level of the upper airway ( P=.016 and .001, respectively). Increased nCPAP pressures also led to changes in the configuration of airway collapse at the level of the velum. Conclusions The differential nCPAP effects observed in this study may help to understand some of the mechanisms responsible for inadequate patient response and poor nCPAP compliance. The use of DISE in combination with CPAP may serve as a first step in optimizing patients that failed to adapt to treatment with CPAP. This approach can help the physician identify patterns of airway collapse that may require varying pressures different from the one the patient is using, as well as anatomical factors that may be corrected to help with compliance. [ABSTRACT FROM AUTHOR]