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Related Concept Videos

Sleep Apnea01:21

Sleep Apnea

Sleep apnea is a condition where breathing stops intermittently during sleep, often leading to significant health issues. Each episode can last from 10 to 20 seconds or more and is frequently accompanied by a brief arousal from sleep. This disturbance, largely unnoticed by the individual, can lead to severe daytime fatigue. Commonly, individuals seek help after being informed by their partners about loud snoring and noticeable breathing pauses during sleep.
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Esophageal Achalasia

Esophageal achalasia is a chronic neurogenic disorder characterized by impaired relaxation of the lower esophageal sphincter (LES) and absent or ineffective peristalsis in the distal esophagus. This leads to a functional obstruction without a physical blockage, despite significant disruption of esophageal motility.EtiologyAchalasia is caused by degeneration of the myenteric (Auerbach's) plexus, specifically the loss of inhibitory ganglion cells that produce vasoactive intestinal peptide (VIP)...
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Patients with esophageal strictures often experience a range of symptoms. Initially, they may have difficulty swallowing solid foods, which can progress to include liquids. Additional symptoms may involve chest pain or discomfort, regurgitating food and fluids, heartburn, unintentional weight loss, coughing or choking during meals, and hoarseness.
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Drug-Induced Sleep Endoscopy (DISE) with Target Controlled Infusion (TCI) and Bispectral Analysis in Obstructive Sleep Apnea
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Obstructive sleep apnea after dynamic sphincter pharyngoplasty.

Russell E Ettinger1, Adam J Oppenheimer, Darryl Lau

  • 1Division of Plastic Surgery, University of Michigan Medical Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA.

The Journal of Craniofacial Surgery
|November 17, 2012
PubMed
Summary

Dynamic sphincter pharyngoplasty (DSP) for velopharyngeal insufficiency (VPI) significantly increases the risk of obstructive sleep apnea (OSA). Previous tonsillectomy/adenoidectomy is a key predictor of developing OSA after DSP, necessitating vigilant screening.

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Area of Science:

  • Otolaryngology
  • Sleep Medicine
  • Pediatric Surgery

Background:

  • Obstructive sleep apnea (OSA) incidence may increase in patients needing further surgery for velopharyngeal insufficiency (VPI).
  • The impact of dynamic sphincter pharyngoplasty (DSP) on OSA is less understood compared to posterior pharyngeal flap surgery.
  • OSA and VPI may exist on a continuum, requiring integrated assessment of speech and airway outcomes.

Purpose of the Study:

  • To determine the incidence of OSA following DSP.
  • To evaluate changes in polysomnography (PSG) parameters after DSP.
  • To identify risk factors associated with OSA development post-DSP.

Main Methods:

  • A 13-year retrospective case series of 146 patients undergoing DSP for VPI.
  • OSA diagnosis based on continuous positive airway pressure therapy prescription.
  • Comparison of preoperative and postoperative OSA incidence and apnea-hypopnea indices (AHIs) using statistical tests.
  • Logistic regression analysis to identify OSA risk factors.

Main Results:

  • OSA incidence increased from 1.4% to 22% post-DSP (P=0.05).
  • Mean AHI significantly rose from 3.1 to 8.4 episodes/hour (P=0.001).
  • Previous tonsillectomy/adenoidectomy was a significant predictor of postoperative OSA (RR=2.4, P=0.04).

Conclusions:

  • DSP is associated with increased OSA incidence and elevated AHIs.
  • Preoperative tonsillectomy/adenoidectomy predicts OSA development after DSP.
  • High suspicion and screening for OSA are crucial in VPI patients undergoing secondary speech surgery.