The role of structured reporting and structured operation planning in functional endoscopic sinus surgery

Computed tomography (CT) scans represent the gold standard in the planning of functional endoscopic sinus surgeries (FESS). Yet, radiologists and otolaryngologists have different perspectives on these scans. In general, residents often struggle with aspects involved in both reporting and operation planning. The aim of this study was to compare the completeness of structured reports (SR) of preoperative CT images and structured operation planning (SOP) to conventional reports (CR) and conventional operation planning (COP) to potentially improve future treatment decisions on an individual level. In total, 30 preoperative CT scans obtained for surgical planning of patients scheduled for FESS were evaluated using SR and CR by radiology residents. Subsequently, otolaryngology residents performed a COP using free texts and a SOP using a specific template. All radiology reports and operation plannings were evaluated by two experienced FESS surgeons regarding their completeness for surgical planning. User satisfaction of otolaryngology residents was assessed by using visual analogue scales. Overall radiology report completeness was significantly higher using SRs regarding surgically important structures compared to CRs (84.4 vs. 22.0%, p<0.001). SOPs produced significantly higher completeness ratings (97% vs. 39.4%, p<0.001) regarding pathologies and anatomical variances. Moreover, time efficiency was not significantly impaired by implementation of SR (148 s vs. 160 s, p = 0.61) and user satisfaction was significantly higher for SOP (VAS 8.1 vs. 4.1, p<0.001). Implementation of SR and SOP results in a significantly increased completeness of radiology reports and operation planning for FESS. Consequently, the combination of both facilitates surgical planning and may decrease potential risks during FESS

Positive airway pressure (PAP) treatment reduces glycated hemoglobin (HbA1c) levels in obstructive sleep apnea patients with concomitant weight loss: Longitudinal data from the ESADA

Patients with obstructive sleep apnea (OSA) are at increased risk of developing metabolic disease such as diabetes. The effects of positive airway pressure on glycemic control are contradictory. We therefore evaluated the change in glycated hemoglobin (HbA1c) in a large cohort of OSA patients after long-term treatment with positive airway pressure. HbA1c levels were assessed in a subsample of the European Sleep Apnea Database [n=1608] at baseline and at long-term follow up with positive airway pressure therapy (mean 378.9±423.0 days). In a regression analysis, treatment response was controlled for important confounders. Overall, HbA1c decreased from 5.98±1.01% to 5.93±0.98% (p=0.001). Patient subgroups with a more pronounced HbA1c response included patients with diabetes (−0.15±1.02, p=0.019), those with severe OSA baseline (−0.10±0.68, p=0.005), those with morbid obesity (−0.20±0.81, p&lt;0.001). The strongest HbA1c reduction was observed in patients with a concomitant weight reduction &gt;5 kilos (−0.38±0.99, p&lt;0.001). In robust regression analysis, severe OSA (p=0.038) and morbid obesity (p=0.005) at baseline, and weight reduction &gt;5 kilos (p&lt;0.001) during follow up were independently associated with a reduction of HbA1c following PAP treatment. In contrast, PAP treatment alone without weight reduction was not associated with significant Hb1Ac reduction. In conclusion, positive airway pressure therapy is associated with HbA1c reduction in patients with severe OSA, in morbidly obese patients. and most obviously in those with significant weight lost during the follow-up. Our study underlines the importance to combine positive airway pressure use with adjustments in lifestyle to substantially modify metabolic complications in OSA

Arterial bicarbonate is associated with hypoxic burden and uncontrolled hypertension in obstructive sleep apnea - The ESADA cohort

Objective: Blood bicarbonate concentration plays an important role for obstructive sleep apnea (OSA) patients to maintain acid-base balance. We investigated the association between arterial standard bicarbonate ([HCO3-]) and nocturnal hypoxia as well as comorbid hypertension in OSA. Methods: A cross-sectional analysis of 3329 patients in the European Sleep Apnea Database (ESADA) was performed. Arterial blood gas analysis and lung function test were performed in conjunction with polysomnographic sleep studies. The 4% oxygen desaturation index (ODI), mean and minimum oxygen saturation (SpO2), and percentage of time with SpO2 below 90% (T90%) were used to reflect nocturnal hypoxic burden. Arterial hypertension was defined as a physician diagnosis of hypertension with ongoing antihypertensive medication. Hypertensive patients with SBP/DBP below or above 140/90 mmHg were classified as controlled-, uncontrolled hypertension, respectively. Results: The [HCO3-] level was normal in most patients (average 24.0 ± 2.5 mmol/L). ODI, T90% increased whereas mean and minimum SpO2 decreased across [HCO3-] tertiles (ANOVA, p = 0.030, &lt;0.001, &lt;0.001, and &lt;0.001, respectively). [HCO3-] was independently associated with ODI, mean SpO2, minimum SpO2, and T90% after adjusting for confounders (β value [95%CI]: 1.21 [0.88–1.54], −0.16 [-0.20 to −0.11], −0.51 [-0.64 to −0.37], 1.76 [1.48–2.04], respectively, all p &lt; 0.001). 1 mmol/L elevation of [HCO3-] was associated with a 4% increased odds of uncontrolled hypertension (OR: 1.04 [1.01–1.08], p = 0.013). Conclusion: We first demonstrated an independent association between [HCO3-] and nocturnal hypoxic burden as well as uncontrolled hypertension in OSA patients. Bicarbonate levels as an adjunctive measure provide insight into the pathophysiology of hypertension in OSA

Management of obstructive sleep apnea in Europe-A 10-year follow-up

Objective: In 2010, a questionnaire-based study on obstructive sleep apnea (OSA) management in Europe identified differences regarding reimbursement, sleep specialist qualification, and titration procedures. Now, 10 years later, a follow-up study was conducted as part of the ESADA (European Sleep Apnea Database) network to explore the development of OSA management over time.Methods: The 2010 questionnaire including questions on sleep diagnostic, reimbursement, treatment, and certification was updated with questions on telemedicine and distributed to European Sleep Centers to reflect European OSA management practice.Results: 26 countries (36 sleep centers) participated, representing 20 ESADA and 6 non-ESADA countries. All 21 countries from the 2010 survey participated. In 2010, OSA diagnostic procedures were performed mainly by specialized physicians (86%), whereas now mainly by certified sleep specialists and specialized physicians (69%). Treatment and titration procedures are currently quite homogenous, with a strong trend towards more Autotitrating Positive Airway Pressure treatment (in hospital 73%, at home 62%). From 2010 to 2020, home sleep apnea testing use increased (76%-89%) and polysomnography as sole diagnostic procedure decreased (24%-12%). Availability of a sleep specialist qualification increased (52%-65%) as well as the number of certified polysomnography scorers (certified physicians: 36%-79%; certified technicians: 20%-62%). Telemedicine, not surveyed in 2010, is now in 2020 used in diagnostics (8%), treatment (50%), and follow-up (73%). Conclusion: In the past decade, formal qualification of sleep center personnel increased, OSA diagnostic and treatment procedures shifted towards a more automatic approach, and telemedicine became more prominent.(c) 2022 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Korrelation der Befunde der dynamischen Posturographie mit dem Ursprungsnerven und der Tumorgröße bei Vestibularisschwannom-Patienten

Einleitung: Vestibularisschwannome (VS) entstehen entweder aus dem superioren oder aus dem inferioren Ast des vestibulären Nerven (SVN oder IVN). Ziel der Studie war zu Testen, ob die zunehmende Größe eines SVN- oder IVN-VS, wie sie sich auf dem Magnetresonanztomogramm abbildet, mit den dynamische Posturographie(DP)-Befunden korreliert und ob mit Hilfe der DP-Befunde der Ursprungsnerv des VS präoperativ bestimmt werden könnte.Methoden: Bei dieser retrospektiven Studie wurden die DP-Befunde 75 Patienten mit VS evaluiert. Condition 5 score (C5S), condition 6 score (C6S), vestibular ratio (VR) und mean overall balance score (MOBS) wurden zur Evaluierung des vestibulären Status der VS-Patienten benutzt. Spearman´sche Korrelationskoeffizienten wurden zwischen dem größten Tumordurchmesser und jeder der vier o.g. DP-Parametern für SVN- und IVN-VS jeweils kalkuliert. Der Ursprungsnerv wurde intraoperativ bestimmt. 21 Patienten hatten einen SVN-VS und 54 Patienten hatten einen IVN-VS. Um zu testen, ob es einen möglichen Unterschied zwischen den DP-Befunden der SVN- und der IVN-Patientengruppen gibt, wurde der Wilcoxon-Mann-Whitney Test angewandt.Ergebnisse: VS-Tumorgröße war mit C5S und VR in IVN-Patienten signifikant korreliert (r=-0,358, p=0,008 und r=-0,356, p=0,008 entsprechend) und nicht-signifikant bei SVN-Patienten korreliert. Weder C6S noch MOBS wiesen eine signifikante Korrelation mit dem größten Tumordurchmesser auf. Keine der o.g. vier Parameter wies einen signifikanten Unterschied zwischen der SVN- und IVN-Patientengruppe auf.Schlussfolgerungen: In der IVN-Patientengruppe korrelieren C5S und VR der DP mit der Tumorgröße. Keine der vier DP-Parameter ermöglicht die präoperative Bestimmung des Ursprungsnervens des VS

Hals-Nasen-Ohren-ärztliche Untersuchungsskala zur Diagnose des Schweregrades eines obstruktiven Schlafapnoe-Syndroms: Pilotstudie

Einleitung: Ziel dieser Studie war, die verschiedenen klinischen Hals-Nasen-Ohren-ärztlichen (HNO) Befunde zu erfassen und mit den polysomnographischen Daten im Hinblick auf den Apnoe-Hypopnoe-Index (AHI) zu vergleichen.Methoden: Die retrospektive Studie basierte auf klinischen HNO-Befunden von 50 Patienten mit Schnarchen als Hauptsymptom (Durchschnittsalter: 52 Jahre). Diese Patienten wurden Hals-Nasen-Ohren-ärztlich untersucht und anhand einer semiquantitativen klinischen Skala ("Mainzer HNO-Schlaf-Index" ("MSI")) analysiert. Die einzelnen klinischen Merkmale wurden mit Punkten, die zum Schluss zusammengefasst wurden, bewertet. Je höher die Punktzahl war, um so höher lag der Schweregrad des obstruktiven Schlafapnoe-Syndroms (OSAS). Bei allen Patienten erfolgte eine Polysomnographie. Anhand des AHI von weniger/mehr als 10 pro Stunde wurden die Patienten in zwei Gruppen aufgeteilt.Ergebnisse: Die maximal erreichbare Punktzahl in der "MSI" lag bei 18 Punkten. Bei 11 von 50 Patienten mit einem AHI10 pro Stunde lag der Wert in der "MSI" bei 12,8±2,5. Patienten mit einem AHIpro Stunde.Schlussfolgerung: Anhand des HNO-Untersuchungsstatus kann die Diagnose und der Schweregrad eines OSAS mit großer Wahrscheinlichkeit beurteilt werden. Weiterhin konnte bei schnarchenden Patienten zwischen einer milderen/schwereren Verlaufsform des OSAS unterschieden werden