Cross motor innervation of the hypoglossal nerve : a pilot study of predictors for successful opening of the soft palate

Purpose!#!Selective hypoglossal nerve stimulation has proven to be a successful treatment option in patients with obstructive sleep apnea. The aim of this pilot study was to investigate if there is a cross-innervation of the hypoglossal nerve in humans and if patients with this phenotype show a different response to hypoglossal nerve stimulation compared to those with ipsilateral-only innervation METHODS: Nineteen patients who previously received a selective hypoglossal nerve stimulation system (Inspire Medical Systems, Golden Valley, USA) were implanted with a nerve integrity system placing electrodes on both sides of the tongue. Tongue motions were recorded one and two months after surgery from transoral and transnasal views. Polysomnography (PSG) was also performed at two months. Electromyogram (EMG) signals and tongue motions after activation were compared with PSG findings.!##!Results!#!Cross-innervation showed significant correlation with bilateral tongue movement and bilateral tongue base opening, which were associated with better PSG outcomes.!##!Conclusion!#!Cross motor innervation of the hypoglossal nerve occurs in approximately 50% of humans, which is associated with a positive effect on PSG outcomes. Bilateral stimulation of the hypoglossal nerve may be a solution for non-responding patients with pronounced collapse at the soft palate during drug-induced sleep endoscopy

Das Münchner Schlafvideoendoskopieprotokoll

Einleitung: In den letzten Jahren werden zur operativen Planung bei obstruktiver Schlafapnoe (OSA) medikamentös induzierte Schlafendoskopien durchgeführt. Im Rahmen dieser Studie sollte geklärt werden, ob die Sedierungstiefe einen Einfluss auf den Grad der Obstruktion und auf das Auftreten verschiedener Obstruktionsmuster der oberen Atemwege hat.Methoden: Eingeschlossen wurden OSA-Patienten mit CPAP-Intoleranz. Im Rahmen des Münchner Schlafvideoendoskopie-Protokolls wurde eine Propofol-Sedierung mittels eines Target-Controlled-Infusion-Systems durchgeführt. Die Sedierungstiefe der Patienten wurde über eine State-Entropie-Messung beurteilt. Der Grad der Obstruktionen wurde anhand der VOTE-Klassifikation auf Velum-, Zungengrund und Epiglottisebene während einer leichten und tiefen Sezierung bestimmt und der Effekt des Esmarch-Manövers dokumentiert.Ergebnisse: Durch eine Vertiefung der Sedierung konnte keine signifikante Änderung des Obstruktionsgrades und Obstruktionsmusters beobachtet werden.Schlussfolgerung: Mit zunehmender Sedierungstiefe und damit verbundener erhöhter Propofolkonzentration ist es zu keiner wesentlichen Änderung des Obstruktionsmusters gekommen. Lediglich zwischen leichter und mittlerer Sedierungstiefe sah man, dass es zu weiteren Obstruktionsorten auf anderen Ebenen (von kranial nach kaudal) kam und dass sich auf Velumebene ein anteriorer-posterior Kollaps in einen konzentrischen Kollaps wandelte. Zwischen mittlerer und tiefer Sedierungstiefe änderte sich der Obstruktionsort und das Obstruktionsmuster nicht.Der Erstautor gibt keinen Interessenkonflikt an

Exploring the differences in epidemiology of treated ESRD between Germany and England and Wales

Background: The aim of this study is to investigate reasons for the large reported differences in renal replacement therapy (RRT) incidence between Germany and England and Wales (E&W).Methods: Age- and sex-standardized incidence rates were calculated at day 0, day 90, and day 180 by using registry data, and early RRT mortality was studied as an indicator of ascertainment differences. Nationally representative health survey data were analyzed to provide general population prevalence data for major chronic kidney disease risk factors: hypertension, diabetes, vascular disease, obesity, and smoking. Resource data were collected from routine sources and national surveys, and literature searches were performed to explore variation in chronic kidney disease prevalence, late referral, early start, and nondialytic therapy.Results: The gap in RRT incidence between Germany and E&W increased after adjusting for differences in early mortality. The standardized day-90 incidence rate ratio was 1.79 (193.0 per million of the adult population [pmap] in Germany and 107.5 pmap in E&W); diabetes and vascular disease explained 79% of this difference. Diabetes, ischemic heart disease, and hypertension were 1.85-, 1.24-, and 1.18-fold more prevalent in Germany, whereas rates of hypertension control were 0.54-fold lower (20% versus 37% in England). Ischemic heart disease mortality rates were lower in Germany.Conclusion: Much of the difference in RRT incidence between Germany and E&W is explained by a greater prevalence of diabetes, hypertension, and vascular disease in the German general population, particularly those older than 65 years, and lower competing mortality risk

GA2LEN skin test study III: minimum battery of test inhalent allergens needed in epidemiological studies in patients

BACKGROUND: The number of allergens to be tested in order to identify sensitized patients is important in order to have the most cost-effective approach in epidemiological studies. OBJECTIVE: To define the minimal number and the type of skin prick test (SPT) allergens required to identify a patient as sensitized using results of the new Pan-European GA(2)LEN skin prick test study. METHOD: In a large Pan-European multicenter (17 centers in 14 countries) patient based study, a standardized panel of 18 allergens has been prick tested using a standardized procedure. Conditional approach allowed to determine the allergens selection. RESULT: Among the 3034 patients involved, 1996 (68.2%) were sensitized to at least one allergen. Overall, eight allergens (grass pollen, Dermatophagoides pteronyssinus, birch pollen, cat dander, Artemisia, olive pollen, Blatella and Alternaria) allowed to identified more than 95% of sensitized subjects. However, differences were observed between countries, two allergens being sufficient for Switzerland (grass pollen and cat dander) as opposed to nine for France (grass pollen, Dermatophagoides pteronyssinus, olive pollen, cat dander, Blatella, cypress, dog dander, alder and [Artemisia or Alternaria]). According to country, up to 13 allergens were needed to identify all sensitized subjects. CONCLUSION: Eight to ten allergens allowed the identification of the majority of sensitized subjects. For clinical care of individual patients, the whole battery of 18 allergens is needed to appropriately assess sensitization across Europe