Positive airway pressure therapy adherence in patients with Co-morbid Insomnia and Sleep apnea (COMISA)

COMISA (Co-morbid insomnia and sleep apnea)는 폐쇄성 수면무호흡증 (OSA, obstructive sleep apnea)과 불면증이 동반되어 있는 질환을 이른다. 본 연구에서는 COMISA 환자의 양압기 순응도를 불면증이 동반되지 않은 OSA 환자와 비교하고 COMISA 환자에서 불면증의 치료가 양압기 순응도에 미치는 영향을 알아보고자 하였다. 2012년 1월부터 2021년 12월까지 OSA 로 양압기치료를 시작한 환자 중에서 불면증으로 정신건강의학과 불면증 클리닉에 의뢰된 환자를 COMISA 군 (n=32) 으로 정의하고 연령과 성별을 1대 2로 짝지은, 불면증을 동반하지 않은 OSA 환자를 대조군 (n=64) 으로 하여 3개월, 9개월 째 두 군의 양압기 사용을 비교하였다. COMISA 군은 불면증 클리닉 내원군 (n=20) 과 미내원군 (n=12) 으로 나누어 임상 특성과 양압기 사용을 비교하였다. COMISA 군과 대조군의 3개월째 (246±160(분) vs. 256±123(분), p=0.767)와 9개월째(182±166(분) vs. 188±143(분), p=0.852)의 양압기 평균사용시간은 차이가 없었고 70%이상의 날짜에 4시간 이상 사용한 환자의 비율도 3개월째 (50% vs. 53.1%, p=0.773)와 9개월째 (34.4% vs. 37.5%, p=0.764)모두 두 군간 차이가 없었다. 불면증 클리닉 내원군과 미내원군의 양압기 평균사용시간은 의뢰 후 3개월째 (260±167(분) vs. 158±182(분), p=0.202)와 9개월째(175±181(분) vs. 64±149(분), p=0.080) 유의한 차이는 없었고 양압기 사용자의 비율도 두 군 간 유의한 차이는 없었다. (85% vs. 58.3% (p=0.116), 55%vs. 16.7% (p=0.062), 각각 3개월, 9개월째) COMISA 환자의 양압기 순응도는 불면증이 동반되지 않은 OSA 환자와 차이가 없었으며 COMISA 환자에서 불면증 클리닉 내원여부는 양압기 순응도에 유의한 영향을 끼치지 않았다. |COMISA (Co-morbid insomnia and sleep apnea) refers to a condition characterized by the coexistence of obstructive sleep apnea (OSA) and insomnia. The objective of this study was to compare the adherence to positive airway pressure (PAP) therapy between COMISA patients and OSA patients without insomnia, as well as to examine the impact of insomnia treatment on PAP adherence. Among patients who were diagnosed with OSA and started PAP therapy between Jan 2012 to Dec 2021, those referred to the Insomnia clinic were defined as the COMISA group (n=32). A control group (n=64) consisting of OSA patients without insomnia was selected, matched in a 1:2 ratio based on age and sex. The PAP adherence of both groups was assessed at 3 and 9 months. Within the COMISA group, patients were further divided into an insomnia clinic visit group (n=20) and a non-visit group (n=12), and their clinical characteristics and PAP use were compared. There was no significant difference in the average PAP use between the COMISA group and the control group at both 3 months (246±160 min vs. 256±123 min, p=0.767) and 9 months (182±166 min vs. 188±143 min, p=0.852). Furthermore, there was no significant difference between the two groups in the proportion of patients who used CPAP for more than 4 hours on at least 70% of days at 3 months (50% vs. 53.1%, p=0.773) and 9 months (34.4% vs. 37.5%, p=0.764). Regarding the comparison within the COMISA group, there was no significant difference in the average PAP use between the insomnia clinic visit group and the non-visit group at 3 months (260±167 min vs. 158±182 min, p=0.202) and 9 months (175±181 min vs. 64±149 min, p=0.080) following referral. Additionally, there was no significant difference in the proportion of PAP users between the two groups at 3 months (85% vs. 58.3%, p=0.116) and 9 months (55% vs. 16.7%, p=0.062), respectively. There was no significant difference in PAP adherence between COMISA patients and OSA patients without insomnia. Additionally, within the COMISA group, visiting an insomnia clinic did not have a significant impact on PAP adherence.Maste

Epiglottic Collapse in Obstructive Sleep Apnea

Along with the development of diagnostic techniques, many studies have been conducted to find the anatomical causes of obstructive sleep apnea (OSA). The velum, oropharynx, tongue base, and epiglottis have been widely considered to be the common obstruction sites. However, the role of the epiglottis in sleep apnea is poorly understood compared to the other anatomical sites. The epiglottis causes OSA either alone or simultaneously with other obstruction sites. We have here reviewed the epidemiology, pathophysiology, diagnosis, and treatment of epiglottic collapse in patients with OSA based on the literature published to date

Alar Lifting Technique for the Correction of Tilted Alar Base

Background: Frequently, a tilted alar base characterized by a discrepant level of the nostril sill and alar insertion on both sides is encountered in patients seeking rhinoplasty. Herein, we report our surgical technique and outcome of alar lifting technique for correcting tilted alar base. Methods: The medical records of 18 patients with alar base asymmetry who underwent rhinoplasty using the alar lift technique between January 2014 and December 2019 were retrospectively reviewed. The alar lifting procedure included a pointed ellipse-shaped excision of vestibular skin just inside the nostril sill, and sutures using 5-0 monocryl. Surgical outcomes were determined on the frontal view of facial images by comparing pre- and postoperative angles formed by a line drawn parallel to the lowermost part of both pupils and a line connecting the lowermost part of the base of the ala. Results: Of 18 patients, 12 (66.7%) were men, and 6 (33.3%) were women. The mean age was 31.8 years (range 16-55). The alar lifting technique was performed on the left side in 12 cases and on the right side in 6 cases, and concurrent tip plasty was performed in 15 (83.3%) cases. The mean alar tilt angle was 3.9 preoperatively and 2.0 postoperatively. The mean angle change was 1.9°. Sixteen (88.9%) out of 18 patients had decreased alar level discrepancy. No patient had complications. Conclusions: Our alar lifting technique can serve as a useful adjunctive technique in rhinoplasty in patients with a tilted ala. Level of evidence iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266

Feasibility of a deep learning-based algorithm for automated detection and classification of nasal polyps and inverted papillomas on nasal endoscopic images

Background Discrimination of nasal cavity mass lesions is a challenging work requiring extensive experience. A deep learning-based automated diagnostic system may help clinicians to classify nasal cavity mass lesions. We demonstrated the feasibility of a convolutional neural network (CNN)-based diagnosis system for automatic detection and classification of nasal polyps (NP) and inverted papillomas (IP). Methods We developed a CNN-based algorithm using a transfer learning strategy and trained it on nasal endoscopic images. A total of 99 nasal endoscopic images with normal findings, 98 images with NP, and 100 images with IP were analyzed using the developed CNN. Six otolaryngologists participated in clinical visual assessment. Image-based classification performance was measured by calculating the accuracy and area under the receiver operating characteristic curve (AUC). The diagnostic performance was compared between the CNN and clinical visual assessment by human experts. Results The algorithm achieved an overall accuracy of 0.742 ± 0.058 with the following class accuracies: normal, 0.81± 0.14; IP, 0.57 ± 0.07; and NP, 0.83 ± 0.21. The AUC values for normal, IP, and NP were 0.91 ± 0.06, 0.82 ± 0.09, and 0.84 ± 0.06, respectively. The overall accuracy of the CNN model was comparable with the average performance of human experts (0.742 vs. 0.749; p = 0.11). Conclusions The trained CNN model appears to reliably classify NP and IP of the nasal cavity from nasal endoscopic images; it also yields a reliable reference for diagnosing nasal cavity mass lesions during nasal endoscopy. However, further studies with more test data are warranted to improve the diagnostic accuracy of our CNN model