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Obstructive sleep apnea syndrome. 2006–2012 multidisciplinary treatment experience
21st ICOMS 2013 - Abstracts: Oral Papers T23.OR009
T23.OR007 Clinical and epidemiological features of OSAS patients. Analysis of nine years in a sleep unit R.
Rojas 1,∗ ,
J.
Lasso 1 ,
M.J. De la
Rivera 2 ,
F.
Alarcón 2 ,
M.
Sepulveda 2
1 Hospital
del Trabajador, Chile 2 Universidad de los Andes, Colombia Background: Classical studies on sleep apnea population have stated a clear pattern of epidemiological, facial and oral characteristics of OSAS patients, that remain until today. Some of those features are still seen in this population, however some have clearly changed and others have emerged. Objectives: To present the results of two studies carried out to analyse epidemiological features (gender, age, level of education and associated diseases) and clinical characteristics (BMI, cervical diameter, facial profile, dental occlusion, nasal and oral structures) of patients evaluated at the Sleep Unit in Hospital del Trabajador, Santiago, Chile. Methods: Retrospective, transversal study of 582 patients who attended to our Sleep Unit from 2003 to 2012. The first study evaluated age, gender, level of education and concomitant diseases of 216 patients with polysomnographic diagnosis of OSAS. The second study analysed anthropometric features (head and neck, oral and nasal structures and some cephalometric measurements) of the same 216 OSAS patients. Fisher exact test was used to asses the association between severity of OSAS with each variable. Risk factors were identified. Results: Some epidemiological variables seen in this population (gender and BMI), showed no difference with that published in classical papers. Other variables, like concomitant diseases and age, showed to be different. Finally, new variables have emerged. Regarding anatomical characteristics of this population, patients with cervical diameter higher than 40 cm, showed strong association with severe OSAS. On the other hand, nasal and oral characteristics showed no association with severity of OSAS. Finally, and contrary to previous data, dental occlusion and facial shape showed no association with severity of OSAS. Discussion: Facial, oral, and some epidemiological characteristics of this population of patients, differ to classical papers, and represent a change in the identification of risk factors and surgical management of OSAS. http://dx.doi.org/10.1016/j.ijom.2013.07.475 T23.OR008 Obstructive sleep apnea syndrome. 2006–2012 multidisciplinary treatment experience J.A. Ruiz-Cruz 1,∗ , N. Montesdeoca Garcia 2 1 Clinica 2
1311
Universidad De Navarra, Pamplona, Spain Clínica la Luz, Madrid, Spain
Background and objectives: The prevalence of the obstructive sleep apnea syndrome (OSAS) is about 4–6% in men and 2–4% in women. It has been calculated that mortality among people sick with severe OSAS is 40% within an eight-year period. Continuous positive airway pressure (CPAP) is the elective treatment for this disease, but it has very low therapeutic adherence (21–50% within 2 years) derived from the discomfort it causes. Methods: The Sleep Unit from Clínica Universidad de Navarra has methodically diagnosed and treated, both medically and surgically, people suspected for OSAS since the year 2006. Between the years 2006 and 2012, 2376 patients underwent complete overnight polysomnography. 97 of them accepted surgical procedures included in phase 1 of Stanford protocol, 21 patients were treated with bimaxilar advancement. Results: 87% of the patient who underwent surgical treatment used CPAP prior surgical procedures and during hospitalization. A healing rate of 86% was achieved in those patients who underwent bimaxilar advancement. An increase in preliminar airway volume is presented as a predictive factor of treatment success. Conclusions: A correct surgical indication in patients who do not tolerate CPAP, can improve symptoms and the parameters analyzed in polysomnographic studies, as well as in 3D images. http://dx.doi.org/10.1016/j.ijom.2013.07.476
The use of intra oral distraction osteogenesis for the treatment of severe upper airway obstructive in children with micrognathia. Seven years of follow up M. Soares UNIFESP/Osteogenesis Institute, Brazil The aim of this paper is to report the use of distraction osteogenesis to lengthening the mandible in order to improve the respiration on the children with severe upper airway obstruction. To patients included presented severe micrognatia showing least 3 symptoms of airway obstruction, being selected a group of 9 children. The ages had an average of 4.3 years old. Five patients required tracheostomy to release airway obstruction. The average oxygen saturation was 74% ranging from 58 to 86%. All the patients were submitted, to intra oral distraction osteogenesis. The patients were evaluated by pulse oximetry, endoscopic examination and mandibular growth. All of the patients submitted to distraction osteogenesis showed an improvement on their breathing conditions elevating the average oxygen saturation to an average 93% ranging from 86 to 96%. On the trachestomized group, four patients were successfully decannulated after the mandibular advancement. One patient the decannulation could not be performed due to the presence of traqueomalacia. With a follow up of 86 months (ranging from 32 to 86 months) no relapse was recorded on the oxygen saturation, however two relapses were recorded. The application of distraction osteogenesis showed excellent results, stability with low morbidity. http://dx.doi.org/10.1016/j.ijom.2013.07.477 T23.OR010 Changes in the upper airway after orthognathic surgery related sleep disorders J.V. Vallejo ∗ , J.I. Cardona, G. Aguilar, L. Guerra Universidad De Antioquia, Colombia Objective: Determinate volumetric dimensional changes in the upper way at the nasopharynx and oropharynx level, after bimaxillary orthognathic and monomaxilar surgery. Population, materials and method: Nineteen adult patients (12 men, 7 women) average age twenty-seven, with class III skeletal deformity, suitable for orthognathic surgeryCT Cone Beam was performed one week before the surgery and three months later, then, maxillofacial and otorhinolaryngologist clinical evaluation was performed. We analysed the normal distribution of variables with Shapiro Wilks; comparison between variables with normal distribution with test T with Wilcoxon signed-rank test. Results: The preoperative maxillofacial-ENT evaluation of the nineteen patients indicated: Signs and symptoms of increased resistance of the upper airway: predisposition mild in nine (47.4%), moderate: seven (36.8%) and severe: one (5.3%). The clinical revaluation three months after orthognathic surgery showed a change in the predispositions 23% of the patients submitted to bimaxilar surgery. 15% changed their resistance from moderate to mild and 8% severe to moderate. Conclusions: There is a tendency to increased volumetric dimension of the upper airways after orthognathic. Mandibular setback surgery reduces the volumetric dimensions of the oropharynx and maxillary advancement surgery outweighs the total volume of the upper airway. Key words: oropharyngeal airway; monomaxilar surgery; bimaxillary surgery; obstructive sleep apnea http://dx.doi.org/10.1016/j.ijom.2013.07.478
T23.OR007 Clinical and epidemiological features of OSAS patients. Analysis of nine years in a sleep unit R.
Rojas 1,∗ ,
J.
Lasso 1 ,
M.J. De la
Rivera 2 ,
F.
Alarcón 2 ,
M.
Sepulveda 2
1 Hospital
del Trabajador, Chile 2 Universidad de los Andes, Colombia Background: Classical studies on sleep apnea population have stated a clear pattern of epidemiological, facial and oral characteristics of OSAS patients, that remain until today. Some of those features are still seen in this population, however some have clearly changed and others have emerged. Objectives: To present the results of two studies carried out to analyse epidemiological features (gender, age, level of education and associated diseases) and clinical characteristics (BMI, cervical diameter, facial profile, dental occlusion, nasal and oral structures) of patients evaluated at the Sleep Unit in Hospital del Trabajador, Santiago, Chile. Methods: Retrospective, transversal study of 582 patients who attended to our Sleep Unit from 2003 to 2012. The first study evaluated age, gender, level of education and concomitant diseases of 216 patients with polysomnographic diagnosis of OSAS. The second study analysed anthropometric features (head and neck, oral and nasal structures and some cephalometric measurements) of the same 216 OSAS patients. Fisher exact test was used to asses the association between severity of OSAS with each variable. Risk factors were identified. Results: Some epidemiological variables seen in this population (gender and BMI), showed no difference with that published in classical papers. Other variables, like concomitant diseases and age, showed to be different. Finally, new variables have emerged. Regarding anatomical characteristics of this population, patients with cervical diameter higher than 40 cm, showed strong association with severe OSAS. On the other hand, nasal and oral characteristics showed no association with severity of OSAS. Finally, and contrary to previous data, dental occlusion and facial shape showed no association with severity of OSAS. Discussion: Facial, oral, and some epidemiological characteristics of this population of patients, differ to classical papers, and represent a change in the identification of risk factors and surgical management of OSAS. http://dx.doi.org/10.1016/j.ijom.2013.07.475 T23.OR008 Obstructive sleep apnea syndrome. 2006–2012 multidisciplinary treatment experience J.A. Ruiz-Cruz 1,∗ , N. Montesdeoca Garcia 2 1 Clinica 2
1311
Universidad De Navarra, Pamplona, Spain Clínica la Luz, Madrid, Spain
Background and objectives: The prevalence of the obstructive sleep apnea syndrome (OSAS) is about 4–6% in men and 2–4% in women. It has been calculated that mortality among people sick with severe OSAS is 40% within an eight-year period. Continuous positive airway pressure (CPAP) is the elective treatment for this disease, but it has very low therapeutic adherence (21–50% within 2 years) derived from the discomfort it causes. Methods: The Sleep Unit from Clínica Universidad de Navarra has methodically diagnosed and treated, both medically and surgically, people suspected for OSAS since the year 2006. Between the years 2006 and 2012, 2376 patients underwent complete overnight polysomnography. 97 of them accepted surgical procedures included in phase 1 of Stanford protocol, 21 patients were treated with bimaxilar advancement. Results: 87% of the patient who underwent surgical treatment used CPAP prior surgical procedures and during hospitalization. A healing rate of 86% was achieved in those patients who underwent bimaxilar advancement. An increase in preliminar airway volume is presented as a predictive factor of treatment success. Conclusions: A correct surgical indication in patients who do not tolerate CPAP, can improve symptoms and the parameters analyzed in polysomnographic studies, as well as in 3D images. http://dx.doi.org/10.1016/j.ijom.2013.07.476
The use of intra oral distraction osteogenesis for the treatment of severe upper airway obstructive in children with micrognathia. Seven years of follow up M. Soares UNIFESP/Osteogenesis Institute, Brazil The aim of this paper is to report the use of distraction osteogenesis to lengthening the mandible in order to improve the respiration on the children with severe upper airway obstruction. To patients included presented severe micrognatia showing least 3 symptoms of airway obstruction, being selected a group of 9 children. The ages had an average of 4.3 years old. Five patients required tracheostomy to release airway obstruction. The average oxygen saturation was 74% ranging from 58 to 86%. All the patients were submitted, to intra oral distraction osteogenesis. The patients were evaluated by pulse oximetry, endoscopic examination and mandibular growth. All of the patients submitted to distraction osteogenesis showed an improvement on their breathing conditions elevating the average oxygen saturation to an average 93% ranging from 86 to 96%. On the trachestomized group, four patients were successfully decannulated after the mandibular advancement. One patient the decannulation could not be performed due to the presence of traqueomalacia. With a follow up of 86 months (ranging from 32 to 86 months) no relapse was recorded on the oxygen saturation, however two relapses were recorded. The application of distraction osteogenesis showed excellent results, stability with low morbidity. http://dx.doi.org/10.1016/j.ijom.2013.07.477 T23.OR010 Changes in the upper airway after orthognathic surgery related sleep disorders J.V. Vallejo ∗ , J.I. Cardona, G. Aguilar, L. Guerra Universidad De Antioquia, Colombia Objective: Determinate volumetric dimensional changes in the upper way at the nasopharynx and oropharynx level, after bimaxillary orthognathic and monomaxilar surgery. Population, materials and method: Nineteen adult patients (12 men, 7 women) average age twenty-seven, with class III skeletal deformity, suitable for orthognathic surgeryCT Cone Beam was performed one week before the surgery and three months later, then, maxillofacial and otorhinolaryngologist clinical evaluation was performed. We analysed the normal distribution of variables with Shapiro Wilks; comparison between variables with normal distribution with test T with Wilcoxon signed-rank test. Results: The preoperative maxillofacial-ENT evaluation of the nineteen patients indicated: Signs and symptoms of increased resistance of the upper airway: predisposition mild in nine (47.4%), moderate: seven (36.8%) and severe: one (5.3%). The clinical revaluation three months after orthognathic surgery showed a change in the predispositions 23% of the patients submitted to bimaxilar surgery. 15% changed their resistance from moderate to mild and 8% severe to moderate. Conclusions: There is a tendency to increased volumetric dimension of the upper airways after orthognathic. Mandibular setback surgery reduces the volumetric dimensions of the oropharynx and maxillary advancement surgery outweighs the total volume of the upper airway. Key words: oropharyngeal airway; monomaxilar surgery; bimaxillary surgery; obstructive sleep apnea http://dx.doi.org/10.1016/j.ijom.2013.07.478