Análisis retrospectivo del tratamiento quirúrgico de la vía aérea superior en la apnea obstructiva del sueño

La cirugía de la vías aérea superior (VAS) es uno de los principales tratamientos del paciente con apnea obstructiva del sueño (AOS). Se presenta una tesis por compendio de publicaciones que recoge cuatro estudios distintos que evalúan los resultados de esta cirugía en sus distintas esferas. Por un lado se comparan las distintas técnicas de faringoplastia utilizadas en el tratamiento del colapso velofaríngeo con el objetivo de conocer cuál es la más exitosa. La faringoplastia de reposición modificada con sutura barbada presenta los mejores resultados, mayor tasa de éxito Sher, mayor reducción relativa del índice de apnea-hipopnea, mayor disminución del índice de desaturación de oxígeno y mejor evolución de los parámetros subjetivos de somnolencia y calidad de vida. Las técnicas de carácter funcional demuestran superioridad frente a las clásicas resectivas. Por otro lado, se investiga la tasa de pacientes que pasan a tener AOS posicional tras ser intervenidos. Esta conversión es otro de los posibles éxitos de la cirugía, ya que mediante la combinación de terapias (cirugía + terapia posicional) los pacientes quedan curados. La tasa de AOS posicional se duplica tras la cirugía y alrededor del 25% queda curado en posición lateral. Adicionalmente se evalúa si los efectos positivos de la cirugía de VAS perduran a largo plazo. Los indicadores de éxito tanto objetivos como subjetivos permanecen estables a lo largo de los sucesivos controles realizados a los 34 y 48 meses tras la intervención. Las técnicas modernas de faringoplastia han demostrado superioridad respecto a las clásicas en términos de estabilidad a largo plazo. Finalmente, se comparan los distintos abordajes terapéuticos en la población pediátrica con AOS para evaluar la superioridad del tratamiento quirúrgico a la vez que se remarca la tasa de AOS residual y por tanto la necesidad de la ya mencionada terapia secuencial o combinación de terapias. En la población pediátrica se hace especial hincapié en la evaluación clínica con múltiples marcadores adaptados al síndrome infantil. Los niños operados obtienen los mejores resultados tanto en términos objetivos como subjetivos. La alternativa médica u observacional no ha demostrado ser igual de efectiva. El resto de terapias como la farmacológica, odontológica o miofuncional no se deben relegar a un segundo plano sino integrarlas como parte de un tratamiento secuencial puesto que la cirugía no consigue curar a todos los pacientes

Daytime Neuromuscular Electrical Therapy of Tongue Muscles in Improving Snoring in Individuals with Primary Snoring and Mild Obstructive Sleep Apnea

Study Objectives: Evaluating daytime neuromuscular electrical training (NMES) of tongue muscles in individuals with Primary Snoring and Mild Obstructive Sleep Apnea (OSA). Methods: A multicenter prospective study was undertaken in patients with primary snoring and mild sleep apnea where daytime NMES (eXciteOSA® Signifier Medical Technologies Ltd., London W6 0LG, UK) was used for 20 min once daily for 6 weeks. Change in percentage time spent snoring was analyzed using a two-night sleep study before and after therapy. Participants and their bed partners completed sleep quality questionnaires: Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI), and the bed partners reported on the nighttime snoring using a Visual Analogue Scale (VAS). Results: Of 125 patients recruited, 115 patients completed the trial. Ninety percent of the study population had some reduction in objective snoring with the mean reduction in the study population of 41% (p < 0.001). Bed partner-reported snoring reduced significantly by 39% (p < 0.001). ESS and total PSQI scores reduced significantly (p < 0.001) as well as bed partner PSQI (p = 0.017). No serious adverse events were reported. Conclusions: Daytime NMES (eXciteOSA®) is demonstrated to be effective at reducing objective and subjective snoring. It is associated with effective improvement in patient and bed partner sleep quality and patient daytime somnolence. Both objective and subjective measures demonstrated a consistent improvement. Daytime NMES was well tolerated and had minimal transient side effects

Transoral awake state neuromuscular electrical stimulation therapy for mild obstructive sleep apnea

IntroductionObstructive sleep apnea (OSA) is a common disorder with major neurocognitive and cardiovascular sequelae. The treatment of symptomatic patients with mild OSA remains controversial given that adherence to positive airway pressure (PAP) has historically been suboptimal. With this notion in mind, we assessed a daily transoral neuromuscular electrical stimulation (NMES) device for individuals with mild OSA.MethodsThe sample represents a subset of participants with a baseline AHI 5-14.9 events/hour, drawn from a parent study which also included participants with primary snoring. Outcome measures for the current study included changes in apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI) and snoring levels before and after use of the NMES.  RESULTS: Among 65 participants (68% men) with median age of 49 years (range 24 to 79) and median BMI of 27.7 kg/m2 (range 20 to 34), the NMES device was used daily for 6 weeks. We observed a significant improvement in the AHI from 10.2 to 6.8 events/hour among all participants and from 10.4 to 5.0 events/h among responders. Statistically significant improvements in the ESS, PSQI, objectively measured snoring, and bed partner-reported snoring were observed. Adherence among all participants was 85%.DiscussionThis NMES device has the benefit of being a treatment modality of daytime therapy which confers a high level of tolerability and patient acceptance. It alleviates the need for an in situ device during sleep and leads to improvements in OSA severity, snoring, and subjective sleep metrics, potentially crucial in mild OSA. Further studies are needed to define which individuals may benefit most from the device across the wider spectrum of OSA severity and assess long-term therapeutic outcomes.Trial registrationClinicalTrials.gov Identifier: NCT03829956

Evaluación subjetiva de las alteraciones del olfato y del gusto en pacientes con afectación leve por COVID-19 en España

International audienceBackground: Has been described the loss of smell and taste as onset symptoms in SARS-CoV-2. The objective of this study was to investigate the prevalence in Spain. Methods: Prospective study of COVID-19 confirmed patients through RT-PCR in Spain. Patients completed olfactory and gustatory questionnaires. Results: A total of 1043 patients with mild COVID-19 disease. The mean age was 39 ± 12 years. 826 patients (79.2%) described smell disorder, 662 (63.4%) as a total loss and 164 (15.7%) partial. 718 patients (68.8%) noticed some grade of taste dysfunction. There was a significant association between both disorders (p<.001). The olfactory dysfunction was the first symptom in 17.1%. The sQOD-NS scores were significantly lower in patients with a total loss compare to normosmic or hyposmic individuals (p =.001). Female were significantly more affected by olfactory and gustatory dysfunctions (p<.001). The early olfactory recover in 462 clinically cured patients was 315 (68.2%), during the first 4 weeks. Conclusion: The sudden onset smell and/or taste dysfunction should be considered highly suspicious for COVID-19 infection