Effect of Sleep Position and Body Mass Index on Severity of Sleep Apnea

Objective:To examine the effects of sleep position and body mass index on obstructive events in adults with obstructive sleep apnea syndrome (OSAS).Methods:The sleep studies of 51 adults with OSAS (apnea- hypopnea index >5/h) were retrospectively evaluated. The study population was classified into obese (body mass index (BMI) >30 kg/m2) and non-obese (BMI0.05). There was no statistically significant difference between non-obese cases and the supine and non-supine values of the obese subjects (p>0.05). There was no difference in the AHI index in the obese and non-obese group in the supine and non-supine position and in NREM periods (p>0.05). The AHI was worse in REM periods. The AHI was worse in all obese and non-obese subjects in the supine position (p<0.05-0.01).Conclusion:In OSAS the AHI was higher in the supine position. Obesity had no additional effect. On the other hand in all subjects while REM, NREM, AHI situations were indifferent, obese subjects AHI index in REM period is worsen

The Ignored Parameter in the Diagnosis of Obstructive Sleep Apnea Syndrome: The Oxygen Desaturation Index

Objective: The apnea-hypopnea index (AHI) does not provide information about the apnea depth and length. We aimed to evaluate the correlation of the oxygen desaturation index (ODI) with AHI and the subjective symptoms because it is known that hypoxia plays an important role in morbidity and complications of obstructive sleep apnea syndrome (OSAS).Methods: We reviewed the data of patients who applied to our clinic between 2010 and 2014 and underwent polysomnography (PSG) with a diagnosis of suspected sleep apnea. The demographic and anthropometric data of the patients were recorded. Epworth sleepiness scale (ESS) and values of AHI and ODI were analyzed in PSG.Results: A total of 321 patients were divided into four groups, according to AHI as follows: 82 (25.5%) common snoring, 77 (24%) mild obstructive sleep apnea (OSA), 71 (22.1%) moderate OSA, and 91 (28.3%) severe OSA. A strong correlation was detected between AHI and ODI (p<0.005 and r=0.904) in all patient groups. There was a positive correlation between AHI and ESS (p<0.05 and r=0.435), but the correlation of ESS with ODI was stronger than that with AHI (p<0.05 and r=0.504).Conclusion: The subjective symptoms of sleep apnea syndrome seem to be closely related to oxygen desaturations. Hypoxia during apnea periods of OSA is important; therefore, we suggest that ODI is as valuable as AHI in diagnosing and grading the OSAS

A Rare Sinonasal Malignancy: Biphenotypic Sinonasal Sarcoma

Biphenotypic sinonasal sarcoma (BSNS), which has been described in the recent years, is a low-grade spindle cell sinonasal sarcoma characterized by rare neural and myogenic features. It has a slow growth pattern; does not metastasize, but local recurrences are common after surgery. Non-specificity of examination findings and symptoms and similarities of its histopathological features with other spindle cell sarcomas, neural tumors, and skeletal muscle-derived tumors involving the nasal cavity make the diagnosis difficult. Therefore, histopathological features should be evaluated together with immunophenotyping and molecular studies for differential diagnosis. There are very few BSNS cases or case series in the literature. In this report, we reported our clinical approach to a case with BSNS in the right nasal cavity and the histopathological features of the disease in the light of the current literature

Pediatric Tracheotomy: A Relatively Rare Indication Limited to Pediatric Intensive Care Subjects?

Objective:To evaluate indications, underlying conditions and outcome in pediatric tracheotomy subjects.Methods:Between January 2004 and September 2013, pediatric subjects who underwent a tracheotomy operation were included for study. All subjects were under the age of 14. Subjects’ primary diseases, indication of tracheotomy, age, gender and type of complications were recorded.Results:Forty five subjects were identified. The mean age of subjects was 26.3 months (range between 2 to 140 months). Twenty one (46.6%) subjects were under the age of 1 year. In 34 (75.5%) out of 45 subjects, tracheotomy indication was prolonged intubation. In the remaining 11 (24.4%) subjects, tracheotomy indication was upper respiratory tract obstruction. Thirteen (n=13- 28.8%) out of 45 experienced early complications and 2 (n=2-4.5%) out of 45 subjects experienced late complications. One tracheotomy related death occurred in the immediate period. Eight (18.1%) of subjects died during the study period from underlying conditions. Decannulation was successfully performed in 13 (36.1%) subjects. In the remaining 23 (63.8%) subjects, decannulation could not be done.Conclusion:All tracheotomies in this report were performed on pediatric intensive care subjects on an elective basis. No tracheotomy was performed for acute upper airway obstruction. Even when planned and elective tracheotomy is performed it still has significant mortality and morbidity

Incidence and Management of Delayed Epistaxis Following Endoscopic Skull Base Surgery

Objective:Among other complications of endoscopic skull base surgery, delayed epistaxis has not been given much importance. This report presents postoperative delayed nosebleed cases in a large number of patients who underwent an endoscopic endonasal transsphenoidal approach to the sellar region for resection of lesions.Methods:Three hundred and sixty three patients who were reached to the sellar region by endoscopic endonasal transsphenoidal route and operated was included in the study. Retrospective chart reviewing of these patients was performed. The correlation between the duration of nosebleeds, bleeding location, treatment methods and comorbidities of the patients were evaluated.Results:Ten patients (3.6%) reported delayed epistaxis in the postoperative period and were referred to the otolaryngology department. Postoperative epistaxis occurred between days 7th and 33th (mean 16.5) days. The treatment consisted of chemical silver nitrate cauterization in two patients, return to the operating room in three patients, nasal packing in five patients.Conclusion:Delayed postoperative epistaxis often has no obvious etiology, and intervention requires teamworking. Well-coordinated teamworking of the neurosurgeon with other specialities such as neuroradiology and otorhinolaryngology is needed to achieve better results

Accessory Nerve Anatomy in Anterior and Posterior Cervical Triangle: A Fresh Cadaveric Study

Objective: To understand the variations and normal course of the accessory nerve (CNXI) to help more accurate and confident neck dissection.Methods: The course of the CNXI in the neck, its relationship to the surrounding anatomic structures and the factors affecting its course were investigated.Results: A total of 100 neck dissections were performed on 50 fresh cadavers. Eleven division variations were observed at the anterior triangle. The location of CNXI at the posterior border of the sternocleidomastoid muscle (PBSCM) was investigated and the ratio between the distance from the mastoid apex (MAA) to CNXI at the PBSCM and the distance from MAA to the posterior border where the PBSCM is attached to the clavicle increased as height of the subject increased (p<0.05).Conclusion: It must be kept in mind that it is better to search for CNXI in taller subjects more inferiorly at the posterior border of the sternocleidomastoid muscle