Diagnosis and treatment of obstructive sleep apnea in otorhinolaryngology
M.V. Komarov, P.D. Potapova
Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech
Snoring and, in particular, obstructive sleep apnea syndrome (OSAS) are a serious problem in modern medicine, requiring an interdisciplinary approach. OSAS affects the cardiovascular, respiratory and endocrine systems and can lead to serious complications. According to literature, the death rate from OSAS is 6–8%. The high prevalence of this pathology and the significant negative impact it has on the quality of life make it necessary to find new safe and effective methods of treatment.
The article highlights modern aspects of diagnostics, presents the tactics of choosing the optimal surgical treatment in the complex therapy of patients with OSAS. Much attention is paid to the issue of surgical treatment of night-time apnea syndrome caused by laryngeal obstruction. Frequently, airway failure at exactly this level is underestimated or not diagnosed at all, which leads to low efficiency of treatment methods aimed at eliminating nasal and oropharyngeal collapse.
Keywords: otorhinolaryngology, obstructive sleep apnea syndrome, snoring, rhonchopathy, polysomnography, sleep endoscopy, OSAS surgical treatment, lingual tonsil resection.
For citation: Komarov M.V., Potapova P.D. Diagnosis and treatment of obstructive sleep apnea in otorhinolaryngology. RMJ. Medical Review. 2019;2(II):59–62.
References
1. American Academy of Sleep Medicine. Sleep-relatedbreathing disorders in adults: recommendations for syndrome definitions and measurements techniques in clinical research. Sleep. 1999;22:667–689.
2. Punjabi N.M., Newman А., Young Т. et al. Sleep disordered breathing and cardiovascular disease: an outcome-based definition of hypopneas Am. J. Respir. Crit. Care Med. 2008;177(10):1150–1155.
3. Berry R.B., Wagner M.H. Obstructive Sleep Apnea in Adults: Epidemiology and Variants. Sleep Medicine Pearls. Saunders, 2014.
4. Колядич Ж.В., Калинкин А.Л. Синдром обструктивного апноэ сна: взгляд оториноларинголога и сомнолога. Терапия. 2016;1:42–50. [Kolyadich Zh.V., Kalinkin A.L. Obstructive sleep apnea syndrome: a view of an otolaryngologist and a somnologist. Therapy. 2016;1:42–50 (in Russ.)].
5. Kezirian E.J., Hohenhorst W., De Vries N. Drug-induced sleep endoscopy: the VOTE classification. Eur Arch Otorhino-laryngol. 2011;268:1233–1236.
6. Strauss R.А. Flexible Endoscopic Nasopharyngoscopy. Atlas Oral Maxillofac Surg. Clin N Am. 2007;15:111–128.
7. George L.T., Barber H.D., Smith В.М. Maxillomandibular Advancement Surgery: An Alternative Treatment Option for Obstructive Sleep Apnea. Atlas Oral Maxillofac Surg Clin N Am. 2007;15:163–177.
8. Kapur V.K., Auckley D.H., Chowdhuri S. et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017;13(3):479–504.
9. Grasso I., Haigney М., Mortara D. et al. Detection of sleep-disordered breathing with ambulatory Holter monitoring. Sleep and Breathing. 2018;22(4):1021–1028.
10. Korcarz C.E., Peppard P.E., Young T.B. et al. Effects of obstructive sleep apnea and obesity on cardiac remodeling: the Wisconsin Sleep Cohort Study. Sleep. 2016;39(6):1187–1195.
11. Melehan K.L., Hoyos C.M., Yee B.J. et al. Increased sexual desire with exogenous testosterone administration in men with obstructive sleep apnea: a randomized placebo-controlled study. Andrology. 2016;4:55–61.
12. Einvik G., Rosjo H., Randby A. et al. Severity of obstructive sleep apnea is associated with cardiac troponin I concentrations in a community-based sample: data from the Akershus Sleep Apnea project. Sleep. 2014;37:1111–1116.
13. Song J. Pathophysiology of Obstructive Sleep Apnea (OSA) — Blood Cells’ Reactive Oxygen Species and Inflammation Prevent Polycythemia. Blood. 2018;132:1028.
14. Арустамян И.Г. Консервативная терапия храпа и синдрома обструктивного апноэ сна в ринологии: автореф. дис. … канд. мед. наук. СПб.; 2017. [Arustamyan I.G. Conservative treatment of snoring and obstructive sleep apnea in rhinology. Thesis. St. Petersburg; 2017 (in Russ.)].
15. Бузунов Р.В., Легейда И.В., Царева Е.В. Храп и синдром обструктивного апноэ сна у взрослых и детей. Практическое руководство для врачей. М.: Litres; 2017. [Buzunov R.V., Legeida I.V., Tsareva E.V. Snoring and Obstructive Sleep Apnea Syndrome in Adults and Children. A practical guide for doctors. M.: Liters; 2017 (in Russ.)].
16. Kiely J.L., Nolan P., McNicholas W.T. Intranasal corticosteroid therapy for obstructive sleep apnea in patients with co-existing rhinitis. Torax. 2004;59(1):50–55.
17. Kushida С.A., Littner M.R., Hirshkowitz М. et al. American Academy of Sleep Medicine. Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep-relatedbreathing disorders. Sleep. 2006:1–29 (3):375–380.
18. Pang К.Р. Tongue Base Radiofrequency Ablation. Advanced surgical techniques in snoring and obstructive sleep apnea. Pluralpublishing. 2013:185–191.
19. Morong S., Rotenberg B.W. Lingual Tonsillectomy Treatment of Sleep Apnea. Advanced surgical techniques in snoring and obstructive sleep apnea. Pluralpublishing, 2013;217:223.
20. Lin H. — S., Rowley J.A., Folbe A.J. et al. Transoral robotic surgery for treatment of obstructive sleep apnea: Factors predicting surgical response. Laryngoscope. 2014;125(4):1013–1020.
21. Woodson B.T., Soose R.J., Gillespie M.B. et al. Three-Year Outcomes of Cranial Nerve Stimulation for Obstructive Sleep Apnea. Otolaryngology-Head and Neck Surgery. 2015;154(1):181–188.
22. Pang К.Р. Tongue Suspension. Advanced surgical techniques in snoring and obstructive sleep apnea. Pluralpublishing. 2013:191–199.
23. Pang К.Р. Hyoid Suspension. Advanced surgical techniques in snoring and obstructive sleep apnea. Pluralpublishing. 2013:229–235.
24. Neruntarat С. Genioglossus Advancement Mandibulotomy. Advanced surgical techniques in snoring and obstructive sleep apnea. Pluralpublishing. 2013:223–229.
25. Woodson B.T., Soose R.J., Gillespie M.B. et al. Three-Year Outcomes of Cranial Nerve Stimulation for Obstructive Sleep Apnea. Otolaryngology-Head and Neck Surgery. 2015;154(1):181–188.
2. Punjabi N.M., Newman А., Young Т. et al. Sleep disordered breathing and cardiovascular disease: an outcome-based definition of hypopneas Am. J. Respir. Crit. Care Med. 2008;177(10):1150–1155.
3. Berry R.B., Wagner M.H. Obstructive Sleep Apnea in Adults: Epidemiology and Variants. Sleep Medicine Pearls. Saunders, 2014.
4. Колядич Ж.В., Калинкин А.Л. Синдром обструктивного апноэ сна: взгляд оториноларинголога и сомнолога. Терапия. 2016;1:42–50. [Kolyadich Zh.V., Kalinkin A.L. Obstructive sleep apnea syndrome: a view of an otolaryngologist and a somnologist. Therapy. 2016;1:42–50 (in Russ.)].
5. Kezirian E.J., Hohenhorst W., De Vries N. Drug-induced sleep endoscopy: the VOTE classification. Eur Arch Otorhino-laryngol. 2011;268:1233–1236.
6. Strauss R.А. Flexible Endoscopic Nasopharyngoscopy. Atlas Oral Maxillofac Surg. Clin N Am. 2007;15:111–128.
7. George L.T., Barber H.D., Smith В.М. Maxillomandibular Advancement Surgery: An Alternative Treatment Option for Obstructive Sleep Apnea. Atlas Oral Maxillofac Surg Clin N Am. 2007;15:163–177.
8. Kapur V.K., Auckley D.H., Chowdhuri S. et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017;13(3):479–504.
9. Grasso I., Haigney М., Mortara D. et al. Detection of sleep-disordered breathing with ambulatory Holter monitoring. Sleep and Breathing. 2018;22(4):1021–1028.
10. Korcarz C.E., Peppard P.E., Young T.B. et al. Effects of obstructive sleep apnea and obesity on cardiac remodeling: the Wisconsin Sleep Cohort Study. Sleep. 2016;39(6):1187–1195.
11. Melehan K.L., Hoyos C.M., Yee B.J. et al. Increased sexual desire with exogenous testosterone administration in men with obstructive sleep apnea: a randomized placebo-controlled study. Andrology. 2016;4:55–61.
12. Einvik G., Rosjo H., Randby A. et al. Severity of obstructive sleep apnea is associated with cardiac troponin I concentrations in a community-based sample: data from the Akershus Sleep Apnea project. Sleep. 2014;37:1111–1116.
13. Song J. Pathophysiology of Obstructive Sleep Apnea (OSA) — Blood Cells’ Reactive Oxygen Species and Inflammation Prevent Polycythemia. Blood. 2018;132:1028.
14. Арустамян И.Г. Консервативная терапия храпа и синдрома обструктивного апноэ сна в ринологии: автореф. дис. … канд. мед. наук. СПб.; 2017. [Arustamyan I.G. Conservative treatment of snoring and obstructive sleep apnea in rhinology. Thesis. St. Petersburg; 2017 (in Russ.)].
15. Бузунов Р.В., Легейда И.В., Царева Е.В. Храп и синдром обструктивного апноэ сна у взрослых и детей. Практическое руководство для врачей. М.: Litres; 2017. [Buzunov R.V., Legeida I.V., Tsareva E.V. Snoring and Obstructive Sleep Apnea Syndrome in Adults and Children. A practical guide for doctors. M.: Liters; 2017 (in Russ.)].
16. Kiely J.L., Nolan P., McNicholas W.T. Intranasal corticosteroid therapy for obstructive sleep apnea in patients with co-existing rhinitis. Torax. 2004;59(1):50–55.
17. Kushida С.A., Littner M.R., Hirshkowitz М. et al. American Academy of Sleep Medicine. Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep-relatedbreathing disorders. Sleep. 2006:1–29 (3):375–380.
18. Pang К.Р. Tongue Base Radiofrequency Ablation. Advanced surgical techniques in snoring and obstructive sleep apnea. Pluralpublishing. 2013:185–191.
19. Morong S., Rotenberg B.W. Lingual Tonsillectomy Treatment of Sleep Apnea. Advanced surgical techniques in snoring and obstructive sleep apnea. Pluralpublishing, 2013;217:223.
20. Lin H. — S., Rowley J.A., Folbe A.J. et al. Transoral robotic surgery for treatment of obstructive sleep apnea: Factors predicting surgical response. Laryngoscope. 2014;125(4):1013–1020.
21. Woodson B.T., Soose R.J., Gillespie M.B. et al. Three-Year Outcomes of Cranial Nerve Stimulation for Obstructive Sleep Apnea. Otolaryngology-Head and Neck Surgery. 2015;154(1):181–188.
22. Pang К.Р. Tongue Suspension. Advanced surgical techniques in snoring and obstructive sleep apnea. Pluralpublishing. 2013:191–199.
23. Pang К.Р. Hyoid Suspension. Advanced surgical techniques in snoring and obstructive sleep apnea. Pluralpublishing. 2013:229–235.
24. Neruntarat С. Genioglossus Advancement Mandibulotomy. Advanced surgical techniques in snoring and obstructive sleep apnea. Pluralpublishing. 2013:223–229.
25. Woodson B.T., Soose R.J., Gillespie M.B. et al. Three-Year Outcomes of Cranial Nerve Stimulation for Obstructive Sleep Apnea. Otolaryngology-Head and Neck Surgery. 2015;154(1):181–188.
This work is licensed under a Creative Commons «Attribution» 4.0 License.
Previous article
Next article
