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10:14: Orthodontic and Orthognathic Surgery for Pediatric OSA
Miniseminars—Monday
UPPP and Subjective Sleep Apnea Outcomes: The SLEEP Study Edward M Weaver, MD, MPH (presenter); B Tucker Woodson, MD; David L Witsell, MD, MHS; Michael G Stewart, MD, MPH; Timothy L Smith, MD, MPH; Bevan Yueh, MD, MPH; Maureen T Hannley, PhD OBJECTIVES: Uvulopalatopharyngoplasty (UPPP) improves polysomnography outcomes, cardiovascular risk, and mortality risk related to sleep apnea; however, its subjective effects are unknown. The presenters’ objective was to test the effectiveness of UPPP on sleep-related quality of life and symptoms. METHODS: This prospective, multisite, community-based case series included sleep apnea patients undergoing UPPP with or without other concomitant procedures, 11/04-11/06. Data were collected pre-UPPP and 3 and 6 months post-UPPP; follow-up data collection is ongoing. The primary outcome was the Functional Outcomes of Sleep Questionnaire (FOSQ, scale 5-20, higher better, normal ⬎17.8); secondary outcomes were the Epworth Sleepiness Scale (scale 0-24, higher worse, normal ⬍10.0) and other symptoms (snoring, morning headache, choking during sleep, awakenings, unrefreshing sleep, daytime fatigue, and problems concentrating). Polysomnography data were collected at baseline. The paired t-test compared pre-UPPP and post-UPPP measures. Stratified prognostic analyses are ongoing. RESULTS: Patients (N⫽242) were enrolled from 33 U.S. sites with diverse practice characteristics. Patients were 45⫹/-12 years, 79% male, 30⫹/-5 kg/m2, with apnea-hypopnea index 36⫹/-26 events/hour. Additional procedures included tongue reduction (36%), septoplasty (16%), and others (each ⬍15%). All outcome variables improved significantly after UPPP. The FOSQ improved from 14.4⫹/-3.3 pre-UPPP to 17.7⫹/-2.6 at 3 months (p⬍0.001) and 17.6⫹/-2.9 at 6 months (P⬍0.001). The Epworth Sleepiness Scale improved from 12.2⫹/-5.2 pre-UPPP to 5.8⫹/-4.0 at 3 months (p⬍0.001) and 5.9⫹/-4.2 at 6 months (p⬍0.001). CONCLUSIONS: UPPP is associated with improvements in
sleep-related quality of life, sleepiness, and other symptoms in a diverse sample of sleep apnea patients. Stratified analyses will test hypothesized predictors of favorable outcome.
10:14 Orthodontic and Orthognathic Surgery for Pediatric OSA Kasey K Li, MD, DDS (presenter) OBJECTIVES: Recent investigations have demonstrated that many children continue to suffer from OSA following T&A. Maxillofacial skeletal abnormalities have been shown to be a major risk factor in having persistent OSA. This study evaluated the outcomes of orthodontic and orthgnathic surgical treatment in children for persistent OSA following T&A. METHODS: Children with persistent OSA following T&A were prospectively evaluated. The orthodontic therapy consisted of rapid maxillary expansion to increase the maxillary arch width as well as orthodontic mandibular alveolar ridge expansion to widen the mandibular arch width. The orthgnathic surgery consisted of either maxillomandibular advancement or mandibular advancement. Polysomnographic variables including respiratory disturbance index (RDI) and lowest oxygen saturation (LSAT) were examined. RESULTS: A total of 25 children underwent orthodontic or orthognathic surgery for persistent OSA after T&A. Sixteen children (mean age 7.9 years old) underwent orthodontic maxillomandibular expansion. Nine children (mean age 14.7 years old) underwent orthognathic surgery where 7 patients underwent maxillomandibular advancement and 2 patients underwent mandibular advancement. In the orthodontic group, mean RDI improved from 8.0 * 4.2 to 1.0 * 1.4 events/hr, and the mean LSAT improved from 92 * 2 to 95 * 1%. In the surgery group, the mean RDI improved from 26.7 * 17.5 to 3.9 * 3.1 events/hr, and the mean LSAT improved from 89.8 * 1.2 to 91.8 * 1.3%. No complications were encountered. CONCLUSIONS: Orthodontic and orthognathic surgery can improve children with persistent OSA after T&A.
10:30 AM to 12:00 PM MINISEMINARS WCC 204ABC
䡲
Miniseminar: Doing the Right Thing . . . in Otolaryngology, Part II Suman Golla, MD (moderator); Amy Y Chen, MD, MPH
Medicine is becoming more and more of a business; as such, numerous forces affect our daily clinical and aca-
demic lives. These include being cognizant of income generation and of academic and industry research support, while simultaneously balancing a life in academia or private practice. Daily dilemmas arise in terms of attachment to and support of industry-generated programs as well as products. In addition, there are genderequality issues that affect the lives of many in our oto-
MONDAY
10:06
P67
UPPP and Subjective Sleep Apnea Outcomes: The SLEEP Study Edward M Weaver, MD, MPH (presenter); B Tucker Woodson, MD; David L Witsell, MD, MHS; Michael G Stewart, MD, MPH; Timothy L Smith, MD, MPH; Bevan Yueh, MD, MPH; Maureen T Hannley, PhD OBJECTIVES: Uvulopalatopharyngoplasty (UPPP) improves polysomnography outcomes, cardiovascular risk, and mortality risk related to sleep apnea; however, its subjective effects are unknown. The presenters’ objective was to test the effectiveness of UPPP on sleep-related quality of life and symptoms. METHODS: This prospective, multisite, community-based case series included sleep apnea patients undergoing UPPP with or without other concomitant procedures, 11/04-11/06. Data were collected pre-UPPP and 3 and 6 months post-UPPP; follow-up data collection is ongoing. The primary outcome was the Functional Outcomes of Sleep Questionnaire (FOSQ, scale 5-20, higher better, normal ⬎17.8); secondary outcomes were the Epworth Sleepiness Scale (scale 0-24, higher worse, normal ⬍10.0) and other symptoms (snoring, morning headache, choking during sleep, awakenings, unrefreshing sleep, daytime fatigue, and problems concentrating). Polysomnography data were collected at baseline. The paired t-test compared pre-UPPP and post-UPPP measures. Stratified prognostic analyses are ongoing. RESULTS: Patients (N⫽242) were enrolled from 33 U.S. sites with diverse practice characteristics. Patients were 45⫹/-12 years, 79% male, 30⫹/-5 kg/m2, with apnea-hypopnea index 36⫹/-26 events/hour. Additional procedures included tongue reduction (36%), septoplasty (16%), and others (each ⬍15%). All outcome variables improved significantly after UPPP. The FOSQ improved from 14.4⫹/-3.3 pre-UPPP to 17.7⫹/-2.6 at 3 months (p⬍0.001) and 17.6⫹/-2.9 at 6 months (P⬍0.001). The Epworth Sleepiness Scale improved from 12.2⫹/-5.2 pre-UPPP to 5.8⫹/-4.0 at 3 months (p⬍0.001) and 5.9⫹/-4.2 at 6 months (p⬍0.001). CONCLUSIONS: UPPP is associated with improvements in
sleep-related quality of life, sleepiness, and other symptoms in a diverse sample of sleep apnea patients. Stratified analyses will test hypothesized predictors of favorable outcome.
10:14 Orthodontic and Orthognathic Surgery for Pediatric OSA Kasey K Li, MD, DDS (presenter) OBJECTIVES: Recent investigations have demonstrated that many children continue to suffer from OSA following T&A. Maxillofacial skeletal abnormalities have been shown to be a major risk factor in having persistent OSA. This study evaluated the outcomes of orthodontic and orthgnathic surgical treatment in children for persistent OSA following T&A. METHODS: Children with persistent OSA following T&A were prospectively evaluated. The orthodontic therapy consisted of rapid maxillary expansion to increase the maxillary arch width as well as orthodontic mandibular alveolar ridge expansion to widen the mandibular arch width. The orthgnathic surgery consisted of either maxillomandibular advancement or mandibular advancement. Polysomnographic variables including respiratory disturbance index (RDI) and lowest oxygen saturation (LSAT) were examined. RESULTS: A total of 25 children underwent orthodontic or orthognathic surgery for persistent OSA after T&A. Sixteen children (mean age 7.9 years old) underwent orthodontic maxillomandibular expansion. Nine children (mean age 14.7 years old) underwent orthognathic surgery where 7 patients underwent maxillomandibular advancement and 2 patients underwent mandibular advancement. In the orthodontic group, mean RDI improved from 8.0 * 4.2 to 1.0 * 1.4 events/hr, and the mean LSAT improved from 92 * 2 to 95 * 1%. In the surgery group, the mean RDI improved from 26.7 * 17.5 to 3.9 * 3.1 events/hr, and the mean LSAT improved from 89.8 * 1.2 to 91.8 * 1.3%. No complications were encountered. CONCLUSIONS: Orthodontic and orthognathic surgery can improve children with persistent OSA after T&A.
10:30 AM to 12:00 PM MINISEMINARS WCC 204ABC
䡲
Miniseminar: Doing the Right Thing . . . in Otolaryngology, Part II Suman Golla, MD (moderator); Amy Y Chen, MD, MPH
Medicine is becoming more and more of a business; as such, numerous forces affect our daily clinical and aca-
demic lives. These include being cognizant of income generation and of academic and industry research support, while simultaneously balancing a life in academia or private practice. Daily dilemmas arise in terms of attachment to and support of industry-generated programs as well as products. In addition, there are genderequality issues that affect the lives of many in our oto-
MONDAY
10:06
P67