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Brain Sciences Oct 2022Nasal obstruction is believed to play a significant role in the pathophysiology and management of obstructive sleep apnea (OSA). However, controversy remains about the... (Review)
Review
Nasal obstruction is believed to play a significant role in the pathophysiology and management of obstructive sleep apnea (OSA). However, controversy remains about the ability of isolated nasal surgery to improve OSA. The objective of this systematic review is to give an updated overview of the literature on whether isolated nasal surgery can improve OSA subjectively (Epworth Sleepiness Scale (ESS)) and/or objectively (polysomnography (PSG)). A systematic review was performed searching the electronic databases PubMed, Embase.com (accessed on 20 June 2022) Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials (CENTRAL) up to 20 June 2022. Eligible studies were reviewed for methodological quality using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Twenty-one studies met the inclusion criteria. The majority of the included studies reported no significant reduction in the apnea-hypopnea index (AHI) after isolated nasal surgery in patients with OSA. The meta-analysis suggests that the AHI slightly decreases after nasal surgery. The ESS was significantly lower after nasal surgery in eighteen studies. Based on the present analysis of objective outcomes, isolated nasal surgery did not improve the AHI significantly in the majority of the studies. The meta-analysis suggests a slight decrease in AHI after nasal surgery, but this reduction is not clinically relevant in terms of treatment success. Isolated nasal surgery should therefore not be recommended as a first-line treatment for OSA. Because of high study heterogeneity, these results should be interpreted with caution. Isolated nasal surgery can possibly improve OSA subjectively. Perhaps only OSA patients with complaints of nasal obstruction or OSA patients experiencing difficulty with continuous positive airway pressure (CPAP) compliance would benefit from isolated nasal surgery.
PubMed: 36358372
DOI: 10.3390/brainsci12111446 -
Canadian Respiratory Journal 2022Obesity is a risk factor for severe airway obstruction and hypoxemia. High-flow nasal cannula (HFNC) is considered as a novel method for oxygen therapy, but the efficacy... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Obesity is a risk factor for severe airway obstruction and hypoxemia. High-flow nasal cannula (HFNC) is considered as a novel method for oxygen therapy, but the efficacy of HFNC for obese patients is controversial. This meta-analysis aimed to assess the efficacy of HFNC compared with conventional oxygen therapy (COT) in obese patients during the perioperative period.
METHODS
We searched the PubMed, Embase, Web of Science, the Cochrane Library, and Google scholar databases for randomized controlled trials (RCTs) that compared the efficacy of HFNC with COT in obese patients during the perioperative period. The primary outcome was the incidence of hypoxemia, while the secondary outcomes included the lowest SpO, the need for additional respiratory support, and the hospital length of stay (LOS).
RESULTS
Twelve trials with 798 obese patients during the perioperative period were included. Compared with COT, HFNC reduced the incidence of hypoxemia (RR, 0.60; 95% CI, 0.43 to 0.83; =0.002; = 24%; 8 RCTs; = 458), increased the lowest SpO (MD, 2.88; 95% CI, 1.53 to 4.22; < 0.0001; = 32%; 5 RCTs; = 264), decreased the need for additional respiratory support (RR, 0.43; 95% CI, 0.21 to 0.88; =0.02; = 0%; 3 RCTs; = 305), and shortened the hospital LOS (MD, -0.31; 95% CI, -0.57 to -0.04; =0.02; = 0%; 3 RCTs; = 214).
CONCLUSIONS
This meta-analysis showed that compared with COT, the use of HFNC was able to reduce the incidence of hypoxemia, increase the lowest SpO, decrease the need for additional respiratory support, and shorten the hospital LOS in obese patients during the perioperative period. Well-organized trials with large sample size should be conducted to support our findings.
Topics: Cannula; Humans; Hypoxia; Noninvasive Ventilation; Obesity; Oxygen; Oxygen Inhalation Therapy; Respiratory Insufficiency
PubMed: 36247078
DOI: 10.1155/2022/4415313 -
Biomedicines Sep 2022Obstructive sleep apnoea (OSA) affects patients' quality of life and health. Magnesium (Mg) is an essential mineral and a potent antioxidant. Mg deficiency can worsen... (Review)
Review
Obstructive sleep apnoea (OSA) affects patients' quality of life and health. Magnesium (Mg) is an essential mineral and a potent antioxidant. Mg deficiency can worsen oxidative stress caused by sleep deprivation or disorders. The impact of OSA on serum Mg levels and its health consequences remain unclear. This study systematically reviewed clinical studies investigating the serum Mg levels of OSA patients and the potential relationships with other biomarkers. Six articles were included for qualitative synthesis and quantitative analysis. Two out of four studies that compared OSA patients to healthy controls found them to have significantly lower serum Mg levels. Our meta-analysis with three studies shows that patients with OSA had significantly lower serum Mg with an effect size of -1.22 (95% CI: -2.24, -0.21). However, the mean serum Mg level of OSA patients ( = 251) pooled from five studies (1.90 mg/dL, 95% CI: 1.77, 2.04) does not differ significantly from the normal range between 1.82 to 2.30 mg/dL. OSA severity appears to affect serum Mg negatively. Serum Mg levels generally improve after treatment, coinciding with the improvement of OSA severity. Low serum Mg levels correlate with the worsening of cardiovascular risk biomarkers of C-reactive protein, ischaemia-modified albumin, and carotid intima-media thickness. The serum Mg levels also potentially correlate with biomarkers for lipid profile, glucose metabolism, calcium, and heavy metals. Sleep deprivation appears to deplete Mg levels of OSA patients, making them at risk of Mg deficiency, which potentially increases systemic inflammation and the risk of cardiovascular and metabolic diseases.
PubMed: 36140382
DOI: 10.3390/biomedicines10092273 -
Brazilian Journal of Otorhinolaryngology 2022Nasal polyps that originate from the sphenoid sinus and reach the nasopharynx are called sphenochoanal polyps. Reports on sphenochoanal polyps in children have thus far... (Review)
Review
OBJECTIVES
Nasal polyps that originate from the sphenoid sinus and reach the nasopharynx are called sphenochoanal polyps. Reports on sphenochoanal polyps in children have thus far been limited only to case reports. This review aims to describe and summarize clinical presentation, diagnosis, management, surgical approaches to the sphenochoanal polyps with recurrence rate after surgery in pediatric patients reported in the literature.
METHODS
A systematic literature review was performed using PubMed, MEDLINE and Cochrane Library Databases for articles published prior to December 2021 to identify all studies reporting on pediatric patients with sphenochoanal polyps. Clinical presentation, management options, surgical approaches and outcomes of applied management were extracted from included studies.
RESULTS
9 articles provided data on 11 eligible patients with an age range 3 years and 8 months-16 years. The commonest symptoms included: nasal obstruction, nasal discharge, and headache respectively. All patients were subjected to surgical treatment. No recurrences after the endoscopic sphenoidotomy were reported.
CONCLUSION
Sphenochoanal polyps should be kept in mind in the differential diagnosis of unilateral nasal cavity or paranasal sinuses masses. Misdiagnosis can result in recurrences in patients with sphenochoanal polyp, who can be mistakenly diagnosed with antrochoanal polyp and underwent inadequate treatment not involving sphenoidotomy and exact identification of the site of implantation. The symptoms of sphenochoanal polyps are nonspecific.
Topics: Humans; Child; Infant; Tomography, X-Ray Computed; Sphenoid Sinus; Nasal Polyps; Nasal Obstruction; Endoscopy
PubMed: 36127268
DOI: 10.1016/j.bjorl.2022.02.006 -
Nutrients Jun 2022Several institutions propose responsive feeding (RF) as the caregivers' relational standard when nurturing a child, from breast/formula feeding onwards. Previous... (Meta-Analysis)
Meta-Analysis Review
Several institutions propose responsive feeding (RF) as the caregivers' relational standard when nurturing a child, from breast/formula feeding onwards. Previous systematic reviews (SRs) on caregivers' feeding practices (CFPs) have included studies on populations from countries with different cultures, rates of malnutrition, and incomes, whereas this SR compares different CFPs only in healthy children (4-24 months) from industrialized countries. Clinical questions were about the influence of different CFPs on several important outcomes, namely growth, overweight/obesity, risk of choking, dental caries, type 2 diabetes (DM2), and hypertension. The literature review does not support any Baby Led Weaning's or Baby-Led Introduction to SolidS' (BLISS) positive influence on children's weight-length gain, nor their preventive effect on future overweight/obesity. RF-CFPs can result in adequate weight gain and a lower incidence of overweight/obesity during the first two years of life, whereas restrictive styles and coercive styles, two kinds of non-RF in CF, can have a negative effect, favoring excess weight and lower weight, respectively. Choking risk: failure to supervise a child's meals by an adult represents the most important risk factor; no cause-effect relation between BLW/BLISS/RF/NRCF and choking could be found. Risks of DM2, hypertension, and caries: different CFPs cannot be considered as a risky or preventive factor for developing these conditions later in life.
Topics: Airway Obstruction; Caregivers; Child; Dental Caries; Diabetes Mellitus, Type 2; Feeding Behavior; Humans; Hypertension; Infant; Infant Nutritional Physiological Phenomena; Noncommunicable Diseases; Obesity; Overweight; Weight Gain
PubMed: 35807827
DOI: 10.3390/nu14132646 -
European Archives of... Sep 2022To this day, there is no cure for recurrent respiratory papillomatosis (RRP). Multiple surgical procedures are performed to achieve symptom relief and prevention of... (Review)
Review
PURPOSE
To this day, there is no cure for recurrent respiratory papillomatosis (RRP). Multiple surgical procedures are performed to achieve symptom relief and prevention of airway obstruction. A promising drug for RRP is the vascular endothelial growth factor (VEGF) binding antibody bevacizumab. This chemotherapeutic agent has an angiogenesis-inhibiting effect which inhibits tumor growth. The objective of this review was to investigate the efficacy of bevacizumab as treatment option for RRP, and to explore the difference of its effects between intralesional and systemic treatment.
METHODS
A systematic search was conducted in Cochrane, PubMed, and Embase. Articles were included if bevacizumab treatment was given intralesionally and/or systemically. The methodological quality of the studies was assessed using the CAse REport (CARE) guidelines.
RESULTS
Of 585 unique articles screened by title and abstract, 15 studies were included, yielding a total of 64 patients. In 95% of the patients treated with systemic bevacizumab, the post-bevacizumab surgical interval was considerably prolonged. More than half of them did not need any surgical intervention during mean follow-up of 21.6 months. Treatment with intralesional bevacizumab showed a lower efficacy: in 62% of the patients, the post-bevacizumab surgical interval (mean, 1.8 months follow-up) was extended when compared to the interval before the treatment.
CONCLUSION
Systemically and intralesionally administered bevacizumab are effective treatment options for severe RRP. A systemic administration might be the treatment of first choice. Further prospective research with long term follow-up is advocated to elucidate this important topic.
Topics: Angiogenesis Inhibitors; Bevacizumab; Humans; Papillomavirus Infections; Respiratory Tract Infections; Vascular Endothelial Growth Factor A
PubMed: 35462578
DOI: 10.1007/s00405-022-07388-6 -
Cureus Feb 2022Obstructive sleep apnea (OSA), is a prevalent condition characterized by repeated episodes of pharyngeal airway obstruction resulting in hypopnea and apnea episodes... (Review)
Review
Obstructive sleep apnea (OSA), is a prevalent condition characterized by repeated episodes of pharyngeal airway obstruction resulting in hypopnea and apnea episodes during sleep leading to nightly awakenings. OSA is a major contributor to the healthcare burden worldwide due to its high cardiovascular morbidity and mortality. There is growing evidence to support a pathophysiological link between OSA and venous thromboembolism (VTE). The pro-inflammatory state along with intermittent hypoxia that is invoked in OSA is associated with blood hypercoagulability, venous stasis, and endothelial dysfunction leading to deep vein thrombosis (DVT) and pulmonary embolism (PE). In this systematic review, we aim to analyze and assess the available literature on OSA and VTE (or DVT/PE) to determine whether OSA is an independent risk factor for VTE.
PubMed: 35371730
DOI: 10.7759/cureus.22729 -
Pediatric Pulmonology Jun 2022Inducible laryngeal obstruction (ILO) in children is underrecognized. This systematic review characterizes the scientific evidence on the impact of pediatric ILO... (Review)
Review
Inducible laryngeal obstruction (ILO) in children is underrecognized. This systematic review characterizes the scientific evidence on the impact of pediatric ILO diagnosis and treatment on asthma medication use. This review, registered with PROSPERO (CRD42020209168), utilized database searches in MEDLINE, EMBASE, CINAHL, and Web of Science from inception to October 2020. Both experimental and observational studies on ILO and asthma outcomes in patients ≤18 years were included. Population characteristics (sample size, sex, age, and comorbidities) and study outcomes (medication usage and respiratory symptoms) were extracted. The risk of bias was assessed with the National Toxicology Program's Office of Health Assessment and Risk of Bias Rating Tool. Data are presented narratively due to study heterogeneity. Of 1091 studies, 1076 titles and abstracts were screened after duplicate removal. Screening 31 full texts yielded eight pre-post studies. Patients were an average of 14.1 years old, 15% male, and >90% used asthma medication; 40% reported allergies, 30% gastroesophageal reflux, and 20% anxiety or depression. Most patients received at least one intervention, with 75% showing symptomatic improvement and >75% decreasing or stopping asthma medications. Studies were small with a high risk of selection, confounding, and detection bias. Asthma management was not a primary outcome in any of the studies. Overall, ILO patients were often diagnosed with or treated for asthma before ILO diagnosis. Evidence from individual studies suggests that comorbidities including ILO, gastroesophageal reflux, allergies, and anxiety should be considered in pediatric patients with asthma not responsive to medical therapy. Further research is required to determine the proportion of impacted asthma patients.
Topics: Adolescent; Airway Obstruction; Asthma; Child; Female; Gastroesophageal Reflux; Humans; Laryngeal Diseases; Male; Syndrome
PubMed: 35355450
DOI: 10.1002/ppul.25910 -
Respiratory Research Mar 2022The assessment of small airways obstruction (SAO) using spirometry is practiced in population-based studies. However, it is not clear what are the most used parameters...
BACKGROUND
The assessment of small airways obstruction (SAO) using spirometry is practiced in population-based studies. However, it is not clear what are the most used parameters and cut-offs to define abnormal results.
METHODS
We searched three databases (Medline, Web of Science, Google Scholar) for population-based studies, published by 1 May 2021, that used spirometry parameters to identify SAO and/or provided criteria for defining SAO. We systematically reviewed these studies and summarised evidence to determine the most widely used spirometry parameter and criteria for defining SAO. In addition, we extracted prevalence estimates and identified associated risk factors. To estimate a pooled prevalence of SAO, we conducted a meta-analysis and explored heterogeneity across studies using meta regression.
RESULTS
Twenty-five studies used spirometry to identify SAO. The most widely utilised parameter (15 studies) was FEF, either alone or in combination with other measurements. Ten studies provided criteria for the definition of SAO, of which percent predicted cut-offs were the most common (5 studies). However, there was no agreement on which cut-off value to use. Prevalence of SAO ranged from 7.5% to 45.9%. As a result of high heterogeneity across studies (I = 99.3%), explained by choice of spirometry parameter and WHO region, we do not present a pooled prevalence estimate.
CONCLUSION
There is a lack of consensus regarding the best spirometry parameter or defining criteria for identification of SAO. The value of continuing to measure SAO using spirometry is unclear without further research using large longitudinal data. PROSPERO registration number CRD42021250206.
Topics: Airway Obstruction; Humans; Respiratory Function Tests; Risk Factors; Spirometry
PubMed: 35313875
DOI: 10.1186/s12931-022-01990-2 -
The Spine Journal : Official Journal of... Sep 2022Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by growing ossifications of spinal entheses and tendons, which may cause trachea and esophagus... (Review)
Review
BACKGROUND AND CONTEXT
Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by growing ossifications of spinal entheses and tendons, which may cause trachea and esophagus compression when located anteriorly in the cervical spine.
PURPOSE
Our previous systematic review on the epidemiological and clinical knowledge of dysphagia and airway obstruction caused by cervical DISH was updated, with a focus on (surgical) treatment and outcomes.
STUDY DESIGN
A systematic review of the literature was performed.
METHODS
Publications in Medline and EMBASE from July 2010 to June 2021 were searched. Two investigators performed data extraction and study specific quality assessment.
RESULTS
A total of 138 articles (112 case reports and 26 case series) were included, describing 419 patients with dysphagia and/or airway obstruction. The mean age of the patient group was 67.3 years (range: 35-91 years), and 85.4% was male. An evident increase of published cases was observed within the last decade. Surgical treatment was chosen for 66% of patients with the anterolateral approach most commonly used. The total complication rate after surgery was 22.1%, with 12.7% occurring within 1 month after intervention. Improvement of dysphagia was observed in 95.5% of operated patients. After a mean follow-up of 3.7 years (range: 0.4-9.0 years), dysphagia recurred in 12 surgically treated patients (4%), of which five patients had osteophyte regrowth.
CONCLUSIONS
The number of published cases of dysphagia in patients with DISH has doubled in the last decade compared to our previous review. Yet, randomized studies or guidelines on the treatment or prevention on recurrence are lacking. Surgical treatment is effective and has low (major) complication rates. Common trends established across the cases in our study may help improve our understanding and management of dysphagia and airway obstruction in cervical DISH.
Topics: Adult; Aged; Aged, 80 and over; Airway Obstruction; Cervical Vertebrae; Deglutition Disorders; Female; Humans; Hyperostosis, Diffuse Idiopathic Skeletal; Male; Middle Aged; Osteophyte
PubMed: 35283294
DOI: 10.1016/j.spinee.2022.03.002