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10:14: Pediatric Sleep Endoscopy
10:14 Pediatric Sleep Endoscopy Mai Thy T Truong, MD (presenter); Peter J Koltai, MD, FAAP; T J O-Lee, MD; Anna H Messner, MD; Kay W Chang, MD OBJECTIVES: 1. Describe the technique of sleep endoscopy for children with polysomnography-proven obstructive sleep apnea (OSA). 2. Determine the value of sleep endoscopy in children with persistent OSA after tonsillectomy and adenoidectomy. 3. Report the polysomnographic results of sleep endoscopy-directed treatment in children with OSA. METHODS: Study Design: Retrospective case series: 20062007. Disease condition studied: pediatric OSA. Patients: 24 children in a tertiary children’s hospital. Interventions: Sleep endoscopy to determine the anatomic site of obstruction to be addressed. Then surgeries may include tonsillectomy, adenoidectomy, radio frequency inferior turbinate reduction, lateral
9:30 AM to 10:30 AM SCIENTIFIC SESSION WCC 204
䡲
Scientific Session Orals: Sleep Disorders Moderators: Colin L W Driscoll, MD; B Tucker Woodson, MD
09:32 RCT of Pantoprazole for Daytime Sleepiness in GERD and OSDB Maria Suurna, MD (presenter); Jeffrey A Welge, PhD; Victoria Surdulescu, MD; Jonathan Kushner, MD; David L Steward, MD OBJECTIVES: Determine the efficacy of proton pump inhibitor therapy with Pantoprazole for daytime somnolence, psychomotor vigilance and quality of life in patients with mild to moderate obstructive sleep disordered breathing (OSDB) and acid reflux symptoms. METHODS: Randomized, double-blind, placebo-control crossover trial. Subjects with daytime sleepiness (ESS⬎8), mild to moderate OSDB (AHI⬍30), and typical symptoms of GERD (heartburn or acid regurgitation) were included in the study. Patients underwent evaluation with validated questionnaires for sleepiness (ESS) and sleeprelated quality-of-life (FOSQ), and psychomotor vigilance (reaction time) testing. Sixty patients were randomly assigned treatment with Pantoprazole 40 mg or placebo once daily for 2 weeks followed by a 2-week washout period and crossover respectively to 2-week treatment with placebo or Pantoprazole. Outcomes were
P65 pharyngoplasty, supraglottoplasty, or lingual tonsillectomy. Outcomes measured: Preoperative and postoperative polysomnogram compared after sleep endoscopy-directed treatment of OSA. Statistical Methods: ANOVA. RESULTS: Twenty-four patients were enrolled. Sleep endoscopy determined the level of obstruction to be at the inferior turbinates (n⫽1), adenoids (n⫽4), tonsils (n⫽7), lingual tonsils (n⫽14), and supraglottic larynx (n⫽7). The preoperative polysomnogram median was RDI/AHI⫽10.9. The postoperative polysomnogram median after sleep endoscopy-directed surgical intervention was RDI/AHI⫽1.15. CONCLUSIONS: Pediatric sleep endoscopy is an effective diagnostic tool in determining the level of airway obstruction in children with OSA where the cause of obstruction is not obvious on routine office examination. It provides anatomically directed treatment especially in those children who have failed conventional therapy.
measured at the beginning and end of each two-week period. RESULTS: Subjects were middle-aged (mean age 51), obese (mean BMI 31) adults with mild to moderate OSDB (mean AHI 10) and excessive daytime somnolence (mean ESS 14). Following treatment with pantoprazole, patients reported statistically significant improvement of overall reflux symptoms when compared to placebo (p⫽0.0003). Further, a statistically significant greater improvement was noted in ESS with pantoprazole when compared to placebo (p⫽0.04). A significant improvement was noted in FOSQ for both pantoprazole and placebo with a trend to greater improvement with pantoprazole (p⫽0.058). No significant improvement in reaction times was observed. CONCLUSIONS: Patients with coexistent GERD and OSDB noted significant improvement in daytime sleepiness following treatment with pantoprazole over placebo.This was likely related to a reduction in nocturnal reflux-related arousals.
09:40 Randomized Crossover Snoring Trial: MRS vs. CPAP Stuart M Robertson, MBChB, MRCS (presenter); Maria Murray; David Young, MPhil, PhD, CStat; John Richard Pilley, MSc, PhD, FDS, RCPS; John H Dempster, MBChB, FRCS OBJECTIVES: 1. Compare the effectiveness of a custom moulded Mandibular Repositioning Splint (MRS) and a nasal Continuous Positive Airway Pressure (CPAP) device for the first-line treatment of disruptive snoring. 2. Determine the
MONDAY
Scientific Sessions—Monday
9:30 AM to 10:30 AM SCIENTIFIC SESSION WCC 204
䡲
Scientific Session Orals: Sleep Disorders Moderators: Colin L W Driscoll, MD; B Tucker Woodson, MD
09:32 RCT of Pantoprazole for Daytime Sleepiness in GERD and OSDB Maria Suurna, MD (presenter); Jeffrey A Welge, PhD; Victoria Surdulescu, MD; Jonathan Kushner, MD; David L Steward, MD OBJECTIVES: Determine the efficacy of proton pump inhibitor therapy with Pantoprazole for daytime somnolence, psychomotor vigilance and quality of life in patients with mild to moderate obstructive sleep disordered breathing (OSDB) and acid reflux symptoms. METHODS: Randomized, double-blind, placebo-control crossover trial. Subjects with daytime sleepiness (ESS⬎8), mild to moderate OSDB (AHI⬍30), and typical symptoms of GERD (heartburn or acid regurgitation) were included in the study. Patients underwent evaluation with validated questionnaires for sleepiness (ESS) and sleeprelated quality-of-life (FOSQ), and psychomotor vigilance (reaction time) testing. Sixty patients were randomly assigned treatment with Pantoprazole 40 mg or placebo once daily for 2 weeks followed by a 2-week washout period and crossover respectively to 2-week treatment with placebo or Pantoprazole. Outcomes were
P65 pharyngoplasty, supraglottoplasty, or lingual tonsillectomy. Outcomes measured: Preoperative and postoperative polysomnogram compared after sleep endoscopy-directed treatment of OSA. Statistical Methods: ANOVA. RESULTS: Twenty-four patients were enrolled. Sleep endoscopy determined the level of obstruction to be at the inferior turbinates (n⫽1), adenoids (n⫽4), tonsils (n⫽7), lingual tonsils (n⫽14), and supraglottic larynx (n⫽7). The preoperative polysomnogram median was RDI/AHI⫽10.9. The postoperative polysomnogram median after sleep endoscopy-directed surgical intervention was RDI/AHI⫽1.15. CONCLUSIONS: Pediatric sleep endoscopy is an effective diagnostic tool in determining the level of airway obstruction in children with OSA where the cause of obstruction is not obvious on routine office examination. It provides anatomically directed treatment especially in those children who have failed conventional therapy.
measured at the beginning and end of each two-week period. RESULTS: Subjects were middle-aged (mean age 51), obese (mean BMI 31) adults with mild to moderate OSDB (mean AHI 10) and excessive daytime somnolence (mean ESS 14). Following treatment with pantoprazole, patients reported statistically significant improvement of overall reflux symptoms when compared to placebo (p⫽0.0003). Further, a statistically significant greater improvement was noted in ESS with pantoprazole when compared to placebo (p⫽0.04). A significant improvement was noted in FOSQ for both pantoprazole and placebo with a trend to greater improvement with pantoprazole (p⫽0.058). No significant improvement in reaction times was observed. CONCLUSIONS: Patients with coexistent GERD and OSDB noted significant improvement in daytime sleepiness following treatment with pantoprazole over placebo.This was likely related to a reduction in nocturnal reflux-related arousals.
09:40 Randomized Crossover Snoring Trial: MRS vs. CPAP Stuart M Robertson, MBChB, MRCS (presenter); Maria Murray; David Young, MPhil, PhD, CStat; John Richard Pilley, MSc, PhD, FDS, RCPS; John H Dempster, MBChB, FRCS OBJECTIVES: 1. Compare the effectiveness of a custom moulded Mandibular Repositioning Splint (MRS) and a nasal Continuous Positive Airway Pressure (CPAP) device for the first-line treatment of disruptive snoring. 2. Determine the
MONDAY
Scientific Sessions—Monday