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Importance: Obstructive sleep apnea (OSA) is associated with a rise in serum inflammatory markers, which may be attenuated by sleep surgery., Objective: To evaluate whether sleep surgery was associated with improved levels of proinflammatory markers in adults with OSA., Data Sources: Two authors independently searched Cochrane, Embase, and PubMed databases from inception through June 14, 2022., Study Selection: Two authors searched the Cochrane, Embase, and PubMed databases for studies comparing preoperative and postoperative levels of serum biomarkers in patients undergoing sleep surgery., Data Extraction and Synthesis: Data were extracted from included articles into a structured proforma. Meta-analyses of the standardized mean difference (SMD) were conducted in random-effects models. To ensure relevance to clinicians and patients, the probability of benefit and number needed to treat were calculated for outcomes that demonstrated a statistically significant effect after sleep surgery., Main Outcomes and Measures: The primary outcome was the preoperative and postoperative levels of serum biomarkers in patients undergoing sleep surgery, including C-reactive protein (CRP), glucose, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and interleukin-6 (IL-6). Data analysis was performed from April to May 2022., Results: Of the 3218 studies screened, 26 studies with 1187 patients (mean [SD] age, 42.8 [11.1] years; 932 [78.5%] men and 255 [21.5%] women) were included. Soft-tissue sleep surgery was associated with a large decrease in CRP (SMD, -0.377; 95% CI, -0.617 to -0.137), total cholesterol (SMD, -0.267; 95% CI, -0.417 to -0.116), LDL (SMD, -0.201; 95% CI, -0.344 to -0.058), IL-6 (SMD, -1.086; 95% CI, -1.952 to -0.221), tumor necrosis factor-α (SMD, -0.822; 95% CI, -1.617 to -0.027), triglyceride (SMD, -0.186; 95% CI, -0.301 to -0.071), and leptin (SMD, -0.519; 95% CI, -0.954 to -0.083) in patients with OSA. Meta-regression highlighted that increased age, higher preoperative score for cumulative sleep time percentage with oxyhemoglobin saturation less than 90% (CT90), and greater change in CT90 postoperatively were associated with a greater decrease in serum CRP levels after soft-tissue sleep surgery. A greater reduction in apnea hypopnea index (AHI) was strongly associated with a greater reduction in total cholesterol and LDL. A greater reduction in body mass index and AHI were also associated with a greater increase in HDL., Conclusions and Relevance: The findings of this systematic review and meta-analysis of 26 studies suggest that sleep surgery is associated with decreased levels of CRP, total cholesterol, LDL, triglyceride, IL-6, leptin, and TNF-α, which may improve the inflammatory and cardiometabolic profile of patients who undergo sleep surgery.

Importance: Three-dimensionally printed nasopharyngeal swabs (3DP swabs) have been used to mitigate swab shortages during the coronavirus disease 2019 (COVID-19) pandemic. Clinical validation for diagnostic accuracy and consistency, as well as patient acceptability, is crucial to evaluate the swab's performance., Objective: To determine the accuracy and acceptability of the 3DP swab for identifying severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)., Design, Setting, and Participants: A diagnostic study was conducted from May to July 2020 at 2 tertiary care centers in Singapore with different reference swabs (FLOQSwab [COPAN Diagnostics] or Dacron swab [Deltalab]) and swab processing techniques (wet or dry) to evaluate the performance of the 3DP swab compared with traditional, standard-of-care nasopharyngeal swabs used in health care institutions. The participants were patients with COVID-19 in the first 2 weeks of illness and controls with acute respiratory illness with negative test results for SARS-CoV-2. Paired nasopharyngeal swabs were obtained from the same nostril and tested for SARS-CoV-2 by reverse-transcriptase polymerase chain reaction. The sequence of swabs was randomized based on odd and even participant numbers., Main Outcomes and Measures: Primary outcome measures were overall agreement (OA), positive percentage agreement (PPA), and negative percentage agreement of the 3DP swab compared with reference swabs. Secondary outcome measures were the correlation of cycle threshold (Ct) values of both swabs., Results: The mean (SD) age of participants was 45.4 (13.1) years, and most participants were men (87 of 89 [97.8%]), in keeping with the epidemiology of the COVID-19 pandemic in Singapore. A total of 79 patients with COVID-19 and 10 controls were recruited. Among the patients with COVID-19, the overall agreement and PPA of the 3DP swab was 91.1% and 93.5%, respectively, compared with reference swabs. The PPA was 100% for patients with COVID-19 who were tested within the first week of illness. All controls tested negative. The reverse-transcriptase polymerase chain reaction Ct values for the ORF1ab and E-gene targets showed a strong correlation (intraclass correlations coefficient, 0.869-0.920) between the 3DP and reference swab on independent testing at each institution despite differences in sample processing. Discordant results for both gene targets were observed only at high Ct values., Conclusions and Relevance: In this diagnostic study of 79 patients with COVID-19 and 10 controls, the 3DP swab performed accurately and consistently across health care institutions and could help mitigate strained resources in the escalating COVID-19 pandemic.

Importance: This study investigates the effectiveness of combined palatal surgery and transoral robotic surgical (TORS) tongue base reduction with partial epiglottidectomy in the treatment of obstructive sleep apnea (OSA) in an Asian context. To our knowledge, this is the first report on TORS for OSA in Asian patients in the literature., Objective: To report our preliminary experience with combined TORS tongue base reduction and partial epiglottidectomy with palatal surgery as a multilevel surgical treatment strategy for moderate to severe OSA in Asian patients for whom positive airway pressure treatment had failed., Design, Setting, and Participants: A retrospective study of prospectively collected data on 40 Asian patients who underwent primary TORS tongue base reduction with partial epiglottidectomy and palatal surgery for treatment of moderate to severe OSA at an academic tertiary surgical center., Interventions: Transoral robotic surgery and palatal surgery for surgical management of OSA in patients for whom positive airway pressure treatment had failed., Main Outcomes and Measures: Twenty patients with complete preoperative and postoperative overnight polysomnograms were evaluated for surgical success and cure, according to traditional surgical criteria, and for subjective outcome measures (snoring and satisfaction on visual analog scale [VAS] and Epworth Sleepiness Scale [ESS]) as well as complications., Results: Traditional cure (apnea-hypopnea index [AHI] <5/h) was achieved in 7 of 20 patients (35%), traditional success (AHI <20 [>50% reduction in AHI]) was achieved in another 11 patients (55%), and failure was observed in 2 patients (10%). Subjective improvement in snoring, satisfaction, and ESS score was observed. Improvement in mean (SD) ESS score and snoring loudness on VAS were statistically significant, from 12.4 (2.87) to 6.4 (1.43) and 8.7 (0.8) to 3.5 (1.7), respectively (P < .001 for both). None of the patients needed postoperative tracheostomy. Recorded complications included tonsillar fossa bleeding, pain, temporary dysgeusia, numbness of the tongue, and temporary dysphagia., Conclusions and Relevance: Transoral robotic surgery for tongue base reduction and partial epiglottidectomy for moderate to severe OSA in Asian patients for whom positive airway pressure treatment had failed is associated with good efficacy and low complication rates.

Importance: Hyoid expansion with suspension can potentially increase the upper airway at the hypopharyngeal level, benefitting patients with sleep-related breathing disorder., Objectives: To document the effect of hyoid expansion using titanium plate and screw on retrolingual hypopharyngeal airway dimension and to compare the airway dimension after isolated hyoid expansion with hyoid expansion + hyomandibular suspension., Design: Anatomical cadaveric dissection study., Setting: This study was performed in a laboratory setting using human cadavers., Intervention: This is an anatomical feasibility study of hyoid expansion using titanium plate and screw on 10 cadaveric human heads and necks. The hyoid bone is trifractured with bony cuts made just medial to the lesser cornu. The freed hyoid body and lateral segments are expanded and stabilized to a titanium adaptation plate. Computer-assisted airway measurement (CAM) was used to measure the airway dimension at the hypopharynx at the level of the tongue base before and after the hyoid expansion. The expanded hyoid bone was then suspended to the mandible, and the airway dimension was measured again with CAM., Main Outcomes and Measures: Airway dimension after isolated hyoid expansion with hyoid expansion with hyomandibular suspension. RESULTS Hyoid expansion with titanium plate and screw resulted in statistical significant increase in the retrolingual hypopharyngeal airway space in all of the 10 human cadavers. The mean (SD) increase in retroglossal area was 33.4 (13.2) mm² (P < .005) (range, 6.0-58.7 mm²). Hyoid expansion with hyomandibular suspension resulted in a greater degree of airway enlargement. The mean (SD) increase in retroglossal area was 99.4 (15.0) mm² (P < .005) (range, 81.9-127.5 mm²)., Conclusions and Relevance: The retrolingual hypopharyngeal airway space increased with hyoid expansion using titanium plate and screw in our human cadaveric study, measured using CAM. The degree of increase is further augmented with hyomandibular suspension.