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American Journal of Otolaryngology 2021Upper airway resistance syndrome (UARS) is a sleep related breathing disorder that was first described in 1993. This goal of this study is to determine the efficacy of... (Meta-Analysis)
Meta-Analysis
PURPOSE
Upper airway resistance syndrome (UARS) is a sleep related breathing disorder that was first described in 1993. This goal of this study is to determine the efficacy of surgical intervention for UARS.
MATERIALS AND METHODS
Systematic review of the literature and a case series of UARS patients at a large integrated healthcare system. Meta-analysis was performed.
RESULTS
For the systematic review, 971 abstracts were reviewed and 3 articles were included, yielding 49 subjects. All of the included studies were of level 3 or 4 evidence. Significant improvement in Epworth Sleepiness Scale (ESS) score was noted after surgery in two level 4 studies. No significant change in ESS was noted in one level 3 study. Our retrospective chart review of eleven UARS patients compared preoperative and postoperative ESS scores, as well as sleep study data. Patients underwent a variety of surgical procedures. Our findings show a significant improvement in mean ESS scores after surgery, from 11.0 (±3.5) to 7.0 (±4.8) with p = 0.01, though no difference in apnea hypopnea index (AHI) and respiratory disturbance index (RDI) were identified. Meta-analysis was performed on 2 studies from the systematic review and our cases series data. UARS surgery showed a mean change in ESS of -5.89 (95% CI, -8.29 to -3.50).
CONCLUSIONS
This systematic review, meta-analysis and retrospective case series indicate that surgery may improve ESS scores in patients with UARS. AHI and RDI are unlikely to be impacted by surgery.
Topics: Adult; Airway Resistance; Female; Humans; Male; Middle Aged; Otorhinolaryngologic Surgical Procedures; Retrospective Studies; Sleep Apnea Syndromes; Treatment Outcome
PubMed: 33831820
DOI: 10.1016/j.amjoto.2021.103011 -
The Laryngoscope Jan 2022Nasal diseases are among the main motives for the early discontinuation of continuous positive airway pressure therapy and for long-term therapeutic compliance with... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Nasal diseases are among the main motives for the early discontinuation of continuous positive airway pressure therapy and for long-term therapeutic compliance with mandibular advancement device. Although our clinical experience leads us to the belief that recumbency impacts nasal airflow in some patient populations, there is no consensus regarding the magnitude of this effect and the specific group of patients who are the most affected by this condition. In this study, we conducted a meta-analysis to assess the effect of the recumbent position on nasal resistance and nasal airflow.
REVIEW METHODS
PubMed (Medline), Cochrane Library, EMBASE, Scopus, and SciELO databases were checked for relevant studies by two members of the YO-IFOS study group. The two authors extracted the data. The main outcome was expressed as the difference between nasal resistance and nasal airflow before and after recumbency.
RESULTS
Nine studies with a total population of 291 individuals were included in the meta-analysis for nasal resistance after recumbency. We found a statistically significant difference in nasal airway resistance of -0.18 Pa sec/cm as compared to before and after recumbency through rhinomanometry (RMM) analysis. A subgroup analysis revealed a variation of -0.20 Pa sec/cm for patients with snoring or sleep apnea and - 0.10 Pa sec/cm for healthy individuals. Regarding nasal airflow measured with RMM, three studies (n = 32) in asymptomatic controls revealed a statistically significant difference of 47.33 ml/sec.
CONCLUSIONS
Recumbency increases nasal resistance and diminishes nasal airflow. This finding is of utmost importance in snorers and sleep apnea patients. Laryngoscope, 132:6-16, 2022.
Topics: Airway Resistance; Humans; Nasal Cavity; Supine Position
PubMed: 33720430
DOI: 10.1002/lary.29509 -
The Impact of Maxillary Expansion on Adults' Nasal Breathing: A Systematic Review and Meta-Analysis.American Journal of Rhinology & Allergy Nov 2021Nasal surgery fails to restore nasal breathing in some cases. Maxillary constriction is suggested as a major cause of failure. It is thought that maxillary constriction... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Nasal surgery fails to restore nasal breathing in some cases. Maxillary constriction is suggested as a major cause of failure. It is thought that maxillary constriction leads to the closure of the internal and external nasal valves. Moreover, it is well established in the literature that maxillary expansion, both in adults and children, increases upper airway volume. However, it is yet unclear whether maxillary expansion may improve nasal function. Pubmed (Medline), the Cochrane Library, EMBASE and Trip Database were checked by two authors from the Rhinology Study Group of the Young Otolaryngologists section of the International Federation of Otorhinolaryngological Societies. Two authors extracted the data. The main outcome was expressed as the value (in variable units) prior to treatment (T0), after expansion procedures (T1), after the retention period (T2), and after a follow-up period (T3).
RESULTS
A total of 10 studies (257 patients) met the inclusion criteria. The data pooled in the meta-analysis reveals a statistically significant reduction of 0.27 Pa/cm/s (CI 95% 0.15, 0.39) in nasal resistance after palatal expansion As far as subjective changes are concerned, the pooled data for the change in the NOSE score shows a statistically significant mean reduction after maxillary expansion of 40.08 points (CI 95% 36.28, 43.89).
CONCLUSION
The initial available evidence is too limited to suggest maxillary expansion as a primary treatment option to target nasal breathing. However the data is encouraging with regards to the effect of maxillary expansion on nasal function. Further higher quality studies are needed in order to define clearer patient selection criteria, distinguish optimal techniques, and demonstrate long-term efficacy in long term follow up studies.
Topics: Adult; Child; Humans; Maxilla; Nasal Cavity; Nose; Palatal Expansion Technique; Respiration
PubMed: 33583193
DOI: 10.1177/1945892421995350 -
International Orthodontics Mar 2021This systematic review assessed the effects of tooth-borne (TB), tooth-bone-borne (TBB) and bone-borne (BB) micro-implant assisted rapid maxillary expansion (RPE) on... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This systematic review assessed the effects of tooth-borne (TB), tooth-bone-borne (TBB) and bone-borne (BB) micro-implant assisted rapid maxillary expansion (RPE) on airway dimensions and function in young children and adolescents (10- to 17-years-old).
MATERIALS AND METHODS
Unrestricted search in 5 electronic databases until June 6th, 2020 was undertaken. This was supplemented with search in 6 additional resources for published, unpublished and ongoing trials up. Randomized (RCT) and non-randomized (Non-RCT) prospective studies that assessed the influence of the mini-screw-assisted rapid palatal expansion (MARPE) approach on airway and breathing in young children and adolescents were included. Two reviewers performed the study selection and data extraction blindly and in duplicate by two authors while disagreements. A random-effects model with a 95% confidence interval (CI), I2 and Chi tests were done. ROBINS-I, Cochrane Risk of Bias and GRADE tools were used. Reporting of this review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
RESULTS
Overall, 518 articles were retrieved; only 3 studies (2 RCT and one non-RCT) met the inclusion criteria. Both TB RPE and BB RPE improved on a short-term basis the dimensions of the airway, though the difference was not significant (P>0.05). TBB RPE significantly improved nasal airflow [(Mean difference (MD) 52.7 cm/s, 95% confidence interval (95% CI) 9.0-96.4), P=0.020)], reduced nasal resistance (MD -0.20Pa/cm, 95% (-0.38)-(-0.02), P=0.028), and changed respiratory muscle strength variables (P>0.05). No correlation was found between the anatomical dimensions of the airway and the functional airway parameters (P>0.05).
CONCLUSIONS
The short-term airway volumetric changes secondary to MARPE were not significant. The influence of MARPE appliances on breathing is still not clear. Registration PROSPERO database (CRD42020183340).
Topics: Adolescent; Bone Screws; Child; Databases, Factual; Humans; Maxilla; Middle Aged; Palatal Expansion Technique; Palate; Respiration
PubMed: 33516650
DOI: 10.1016/j.ortho.2021.01.004 -
BMJ Open Respiratory Research Dec 2020Asthma is a common, heterogeneous disease that is characterised by chronic airway inflammation and variable expiratory airflow limitation. Current guidelines use...
BACKGROUND
Asthma is a common, heterogeneous disease that is characterised by chronic airway inflammation and variable expiratory airflow limitation. Current guidelines use spirometric measures for asthma assessment. This systematic review aimed to assess whether the most commonly reported tests of small airways function could contribute to the diagnosis of asthma.
METHODS
Standard systematic review methodology was used, and a range of electronic databases was searched (Embase, MEDLINE, CINAHL, CENTRAL, Web of Science, DARE). Studies that included physiological tests of small airways function to diagnose asthma in adults were included, with no restrictions on language or date. The risk of bias and quality assessment tools used were Agency for Healthcare Research and Quality tool for cross-sectional studies and Quality Assessment of Diagnostic Accuracy Studies 2 for diagnostic test accuracy (DTA) studies.
RESULTS
7072 studies were identified and 10 studies met review criteria. 7 included oscillation techniques and 5 included maximal mid-expiratory flow (MMEF). Studies were small and of variable quality. In oscillometry, total resistance (R5) and reactance at 5 Hz (X5) was altered in asthma compared with healthy controls. The percentage predicted of MMEF was lower in patients with asthma compared with controls in all studies and lower than the % predicted forced expiratory volume in 1 s. In DTA of oscillometry, R5 showed a sensitivity between 69% and 72% and specificity between 61% and 86%.
CONCLUSION
There were differences in the results of physiological tests of small airway function in patients with asthma compared with controls. However, studies are small and heterogeneous. Further studies are needed to assess the effectiveness of these tests on a larger scale, including studies to determine which test methodology is the most useful in asthma.
Topics: Adult; Asthma; Cross-Sectional Studies; Diagnostic Tests, Routine; Forced Expiratory Volume; Humans; Spirometry; United States
PubMed: 33371011
DOI: 10.1136/bmjresp-2020-000770 -
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue Aug 2020To systematically review the effect of Tongfu Xiefei method on prognosis and respiratory mechanics parameters in patients with acute respiratory distress syndrome (ARDS). (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To systematically review the effect of Tongfu Xiefei method on prognosis and respiratory mechanics parameters in patients with acute respiratory distress syndrome (ARDS).
METHODS
The randomized controlled trials (RCT) of Tongfu Xiefei method for ARDS published on PubMed, Web of Science, Embase, CNKI and Wanfang database from January 1st 2001 to June 30th 2019 were searched. Conventional treatment for ARDS that included mechanical ventilation, prone ventilation, anti-infection, organ function maintenance and nutritional therapy were used in the control group. While the Tongfu Xiefei method was applied in the experimental group based on the conventional treatment. The main outcome was in-hospital mortality, and the secondary outcomes included mechanic ventilation time, length of intensive care unit (ICU) stay and respiratory mechanics parameters. Two researchers independently searched the literature, collected data and assessed the risk of bias. The bias risk assessment was completed by RevMan 5.3 software. The Meta-analysis was completed by R software. The potential publication bias of main outcome was evaluation.
RESULTS
A total of 27 RCTs were included. There were 1 763 patients, including 899 in the experimental group and 864 in the control group. Meta-analysis showed that, compared with the control group, the in-hospital mortality of the experimental group significantly decreased [relative risk (RR) = 0.46, 95% confidence interval (95%CI) was 0.36 to 0.59, P < 0.000 1], the mechanic ventilation time and the length of ICU stay were significantly shortened [mechanical ventilation time: standard mean difference (SMD) = -1.92, 95%CI was -2.56 to -1.29, P < 0.000 1; length of ICU stay: SMD = -1.84, 95%CI was -2.49 to -1.18, P < 0.000 1], oxygenation index was significantly improved (SMD = 2.26, 95%CI was 1.56 to 2.96, P < 0.000 1), airway peak pressure, airway platform pressure, mean airway pressure and airway resistance significantly decreased (airway peak pressure: SMD = -1.26, 95%CI was -2.35 to -0.18, P = 0.021 8; airway platform pressure: SMD = -0.61, 95%CI was -1.08 to -0.14, P = 0.010 7; mean airway pressure: SMD = - 1.67, 95%CI was - 2.93 to -0.42, P = 0.009 1; airway resistance: SMD = -0.88, 95%CI was -1.09 to -0.67, P < 0.000 1), while lung compliance increased (SMD = 1.57, 95%CI was 0.78 to 2.36, P < 0.000 1). The results of publication bias assessment showed that there was no potential publication bias (P = 0.499).
CONCLUSIONS
Tongfu Xiefei method is capable of reducing the in-hospital mortality, shortening the mechanical ventilation time and the length of ICU stay, and improving respiratory mechanics parameters for patients with ARDS.
Topics: Hospital Mortality; Humans; Intensive Care Units; Lung Compliance; Medicine, Chinese Traditional; Respiratory Distress Syndrome; Respiratory Mechanics
PubMed: 32912412
DOI: 10.3760/cma.j.cn121430-20200506-00361 -
Sleep Medicine Oct 2019Obstructive sleep apnea/hypopnea syndrome (OSAHS) is a very common, yet undiagnosed, breathing disorder that has many more implications besides disrupted sleep. Its role... (Meta-Analysis)
Meta-Analysis
Efficacy of continuous positive airway pressure (CPAP) preventing type 2 diabetes mellitus in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and insulin resistance: a systematic review and meta-analysis.
BACKGROUND
Obstructive sleep apnea/hypopnea syndrome (OSAHS) is a very common, yet undiagnosed, breathing disorder that has many more implications besides disrupted sleep. Its role as an independent risk factor for metabolic abnormalities such as insulin resistance (IR) and impaired glucose tolerance is becoming increasingly recognized. The main treatment for OSAHS is continuous positive airway pressure (CPAP), however the impact of CPAP on IR and glucose metabolism is still debated.
OBJECTIVES
Compile all available evidence regarding the effect of CPAP on IR in non-diabetic OSA patients.
METHODS
A literature search in Medline, Epistemonikos and the Cochrane Controlled Trial Register were searched through March 2018. We included Randomized Controlled Trials (RCTs) comparing CPAP treatment with sham CPAP, placebo or no treatment in non-diabetic adults with OSAHS. Risk of Bias was evaluated using Cochrane tool and a meta-analysis evaluating the efficacy of CPAP in both HOMA index and fasting glucose was done. Certain of evidence was rated using GRADE approach.
RESULTS
Nine studies consisting of 443 participants were included. CPAP treatment significantly improved HOMA index (Mean difference = -0.39 Ui (CI, -0.69 to -0.08), p < 0.05. I2 = 57% (GRADE = LOW). However, CPAP showed no significant changes in fasting glucose (GRADE = LOW).
CONCLUSION
This systematic review and meta-analysis shows evidence that metabolic disturbances could be halted and regressed with CPAP treatment in patients with insulin resistance and OSAHS. In conclusion, treatment with CPAP could improve HOMA IR index.
Topics: Adult; Case-Control Studies; Continuous Positive Airway Pressure; Diabetes Mellitus, Type 2; Female; Glucose Intolerance; Humans; Insulin Resistance; Male; Middle Aged; Placebo Effect; Randomized Controlled Trials as Topic; Risk Factors; Sleep Apnea, Obstructive; Treatment Outcome
PubMed: 31518943
DOI: 10.1016/j.sleep.2018.12.017 -
The Journal of Allergy and Clinical... Nov 2019Asthma causes the unpleasant sensation of breathlessness (dyspnea) caused by airway obstruction. Patients with poor perception of airway obstruction are at risk of delay...
BACKGROUND
Asthma causes the unpleasant sensation of breathlessness (dyspnea) caused by airway obstruction. Patients with poor perception of airway obstruction are at risk of delay in seeking medical attention and undertreatment, which can lead to avoidable deaths. Conversely, those with heightened perception are at risk of overtreatment and iatrogenic adverse effects with reliever medications, anxiety, and unnecessary use of health care resources.
OBJECTIVE
We sought to review evidence about symptom misperception in asthmatic patients and how to identify and manage affected patients, particularly with regard to reliever medications.
METHODS
We conducted a systematic literature search for studies of perception of airway function in asthmatic patients. We searched the OVID (Medline and Medline [R] in process [PubMed]), Embase, and Adisearch/Odyssey databases, restricting our search to human studies published in English from 1990-2018, with no restrictions on age, sex, or racial origin.
RESULTS
We found that both underperception and overperception assessed during induced bronchoconstriction or bronchodilation or during changes in airway resistance were common across all age groups and that aging, disease severity, smoking, sex, ethnicity, psychologic factors, and medication are all associated with differences in perception. Importantly, airway inflammation was associated with impaired perception and a history of severe or near-fatal asthma. We also identified knowledge gaps, such as whether an individual patient's perception varies over time and the influence perception has on patients' use of reliever medication.
CONCLUSION
We found that abnormal perception of airway obstruction has important clinical implications for the management of patients with asthma.
Topics: Airway Obstruction; Animals; Asthma; Bronchial Provocation Tests; Bronchoconstriction; Diagnostic Errors; Dyspnea; Humans; Inflammation; Perception
PubMed: 31330221
DOI: 10.1016/j.jaci.2019.06.040 -
Journal of Oral Rehabilitation Nov 2019This systematic review aimed to assess the effects of bicuspid extractions and incisor retraction on airway dimension, hyoid position and breathing of adults and late...
OBJECTIVES
This systematic review aimed to assess the effects of bicuspid extractions and incisor retraction on airway dimension, hyoid position and breathing of adults and late adolescents.
METHODS
The review was conducted according to PRISMA guidelines. Eight databases including PubMed, EMBASE, Web of Science and Scopus were searched to August 2018. Minimum age of participants was 16 years. The intervention was dual-arch bicuspid extractions with incisor retraction. Outcomes were airway dimension, hyoid position and breathing assessment.
RESULTS
All nine publications meeting inclusion criteria were from Asia. They were divided into three Asian subregions. All East Asian lateral cephalometric studies reported anteroposterior airway narrowing at the oropharynx and sometimes the hypopharynx. However, the narrowing was small, comparable to measurement errors, and highly variable. Two out of three East Asian computed tomography (CT) studies described reductions in airway dimensions. The single functional breathing study showed increased simulated flow resistance after incisor retraction in East Asians. South Asian studies had mixed findings, with some reporting significant airway narrowing. The single study from West Asia found no significant airway or hyoid changes.
CONCLUSIONS
Airway response to bicuspid extractions and incisor retraction varied substantially when assessed with cephalometry. CT measurements present larger effect sizes and smaller variations, providing stronger evidence of airway narrowing. Orthodontic extractions for incisor retraction may be more frequently indicated in Asia, and East Asians seem particularly susceptible to airway narrowing and postero-inferior hyoid movement with incisor retraction. Better designed CT studies are needed for confirmation due to small effect size and large variability.
Topics: Adolescent; Adult; Bicuspid; Cephalometry; Humans; Hyoid Bone; Incisor; Oropharynx
PubMed: 31281971
DOI: 10.1111/joor.12854