Impact of thyroidectomy on the control of obstructive sleep apnea syndrome in patients with large goiters

A large goiter can cause a series of compressive symptoms such as dyspnea and dysphagia, and previous case reports have indicated the coexistence of obstructive sleep apnea syndrome (OSAS) in these patients. the aim of this study was to evaluate the impact of thyroidectomy on the control of OSAS in patients with large goiters.Twenty-four patients with euthyroid goiters larger than 100 ml were consecutively selected. of these, 17 (70.8 %) presented OSAS and formed the research group. the protocol consisted of sleep questionnaires, physical examination, and polysomnography in baseline and after 3 months of surgery.The average age of the patients was 58.3 +/- 9.9 years, and there were 5 (29.4 %) males and 12 (70.6 %) females. the significant findings in the postoperative period included a reduced neck circumference (p = 0.041), reduced Epworth sleepiness score (p = 0.025), decreased percentage of high-risk OSAS cases according to the Berlin questionnaire (p < 0.001), and a tendency for a significant reduction in snoring (p = 0.052). However, polysomnographic respiratory parameters showed no significant improvement after surgery.Despite the high prevalence of OSAS in patients with large goiters and the improvement of OSAS symptoms, thyroidectomy showed no significant impact on the polysomnographic parameters.AFIPFundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Universidade Federal de São Paulo, UNIFESP, Dept Otorrinolaringol & Cirurgia Cabeca & Pescoco, BR-04024002 São Paulo, BrazilUniversidade Federal de São Paulo, UNIFESP, Disciplina Med & Biol Sono, Dept Psicobiol, BR-04024002 São Paulo, BrazilUniversidade Federal de São Paulo, UNIFESP, Dept Otorrinolaringol & Cirurgia Cabeca & Pescoco, BR-04024002 São Paulo, BrazilUniversidade Federal de São Paulo, UNIFESP, Disciplina Med & Biol Sono, Dept Psicobiol, BR-04024002 São Paulo, BrazilWeb of Scienc

New Insights on the Pathophysiology of Inspiratory Flow Limitation During Sleep

Inspiratory flow limitation (IFL) is defined as a flattened shape of inspiratory airflow contour detected by nasal cannula pressure during sleep and can indicate increased upper airway resistance especially in mild sleep-related breathing disorders (SRBD). the objective of this study was to investigate the association between upper airway abnormalities and IFL in patients with mild SRBD.This study was derived from a general population study consisting of selected individuals with apnea-hypopnea index (AHI) below 5 events/h of sleep, (no obstructive sleep apnea group) and individuals with AHI between 5 and 15 events/h (mild obstructive sleep apnea group). A total of 754 individuals were divided into four groups: group 1: AHI 30 % of TST with IFL (46 individuals), group 3: AHI: 5-15/h and 30 % of TST with IFL (25 individuals).Individuals with complains of oral breathing demonstrated a risk 2.7-fold larger of being group 4 compared with group 3. Abnormal nasal structure increased the chances of being in group 4 3.2-fold in comparison to group 1. Individuals with voluminous lateral wall demonstrated a risk 4.2-fold larger of being group 4 compared with group 3.More than 30 % of TST with IFL detected in sleep studies was associated with nasal and palatal anatomical abnormalities in mild SRBD patients.Associacao Fundo de Incentivo a Pesquisa (AFIP)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Universidade Federal de São Paulo, Dept Psicobiol, Disciplina Med & Biol Sono, BR-04024002 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Otorrinolaringol & Cirurgia Cabeca Pescoco, BR-04024002 São Paulo, BrazilNYU, Sch Med, Div Pulm & Crit Care Med, New York, NY USAUniversidade Federal de São Paulo, Dept Psicobiol, Disciplina Med & Biol Sono, BR-04024002 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Otorrinolaringol & Cirurgia Cabeca Pescoco, BR-04024002 São Paulo, BrazilWeb of Scienc

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p&lt;0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p&lt;0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status