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upper airway obstruction

Anupriya Tripathi, Alexey V Melnik, Jin Xue, Orit Poulsen, Michael J Meehan, Gregory Humphrey, Lingjing Jiang, Gail Ackermann, Daniel McDonald, Dan Zhou, Rob Knight, Pieter C Dorrestein, Gabriel G Haddad
Obstructive sleep apnea (OSA) is a common disorder characterized by episodic obstruction to breathing due to upper airway collapse during sleep. Because of the episodic airway obstruction, intermittently low O2 (hypoxia) and high CO2 (hypercapnia) ensue. OSA has been associated with adverse cardiovascular and metabolic outcomes, although data regarding potential causal pathways are still evolving. As changes in inspired O2 and CO2 can affect the ecology of the gut microbiota and the microbiota has been shown to contribute to various cardiometabolic disorders, we hypothesized that OSA alters the gut ecosystem, which, in turn, exacerbates the downstream physiological consequences...
May 2018: MSystems
S R Devarajan, N Zarrin-Khameh, P Alapat
We present a case of a 76 year-old, non-smoking Honduran female who was referred to our clinic for years of persistent dry cough. Cardiac evaluation was unremarkable. She denied symptoms of heartburn, allergic rhinitis, and there was no personal or family history of asthma. Her physical exam demonstrated wheezing over the right mid-posterior chest. Spirometry was within normal limits. CT-imaging of the chest demonstrated right middle lobe bronchus and lingular segmental bronchus narrowing with bibasilar atelectasis and mild interlobular septal thickening with prominent mediastinal adenopathy...
2018: Respiratory Medicine Case Reports
Sarp Aksel, Laura Lang, Jody E Steinauer, Eleanor A Drey, Lauren Lederle, Abby Sokoloff, A Sue Carlisle
OBJECTIVE: To estimate the incidence of pulmonary aspiration and other anesthesia-related adverse events in women undergoing dilation and evacuation (D&E) under intravenous deep sedation without tracheal intubation in an outpatient setting. METHODS: We reviewed all D&Es done under anesthesiologist-administered intravenous deep sedation without tracheal intubation between February 2009 and April 2013. The study's primary outcome was pulmonary aspiration; secondary outcomes included other anesthesia-related complications...
June 6, 2018: Obstetrics and Gynecology
James Jordan Johnston, Richard Douglas
Pathogenic bacteria associated with the adenoids and tonsils cause much morbidity in the paediatric population. Hyperplasia of the adenoids is associated with otitis media with effusion and hyperplasia of the palatine tonsils is associated with both recurrent tonsillitis and obstructive sleep apnoea. Most current knowledge of the microbiology of the upper airways has been derived from culture-based studies, which usually reflect only a small fraction of the bacteria present on the mucosal surface. Culture-independent molecular surveys based on 16S ribosomal RNA sequencing are now being employed to determine the microbiota on the surface and within the tissue of adenoids and palatine tonsils...
June 8, 2018: Postgraduate Medical Journal
Yusi Miao, Joseph C Jing, Vineet Desai, Sari B Mahon, Matthew Brenner, Livia A Veress, Carl W White, Zhongping Chen
Development of effective rescue countermeasures for toxic inhalational industrial chemicals, such as methyl isocyanate (MIC), has been an emerging interest. Nonetheless, current methods for studying toxin-induced airway injuries are limited by cost, labor time, or accuracy, and only provide indirect or localized information. Optical Coherence Tomography (OCT) endoscopic probes have previously been used to visualize the 3-D airway structure. However, gathering such information in small animal models, such as rat airways after toxic gas exposure, remains a challenge due to the required probe size necessary for accessing the small, narrow, and partially obstructed tracheas...
June 7, 2018: Scientific Reports
Matthew Schiefer, Jenniffer Gamble, Kingman Perkins Strohl
Obstructive sleep apnea (OSA) is a disorder characterized by collapse of the velopharynx and/or oropharynx during sleep when drive to the upper airway is reduced. Here, we explore an indirect approach for activation of upper airway muscles which might affect airway dynamics- unilateral electrical stimulation of the afferent fibers of the sciatic nerve- in an anesthetized rabbit model. A nerve cuff electrode was placed around the sciatic and hypoglossal nerves to deliver stimulus while air flow, air pressure, and alae nasi electromyogram (EMG) were monitored both prior to and after sciatic transection...
June 7, 2018: Journal of Applied Physiology
Richard A Hopper, Hitesh Kapadia, Srinivas Susarla, Randall Bly, Kaalan Johnson
BACKGROUND: The craniofacial rotation deformity in Treacher Collins syndrome (TCS) results in airway compression that is not adequately addressed by isolated mandibular distraction osteogenesis (MDO). The purpose of this work is to present a novel surgical technique, counterclockwise craniofacial distraction osteogenesis (C3DO), to improve the airway morphology and occlusion in tracheostomy-dependent patients with TCS. METHODS: This is a prospective study of tracheostomy-dependent children with TCS who underwent C3DO...
May 19, 2018: Plastic and Reconstructive Surgery
Joy W Lee, Tunn Ren Tay, Paul Paddle, Amanda L Richards, Lisa Pointon, Miriam Voortman, Michael J Abramson, Ryan Hoy, Mark Hew
BACKGROUND: Inducible laryngeal obstruction, an induced, inappropriate narrowing of the larynx, leading to symptomatic upper airway obstruction, can coexist with asthma. Accurate classification has been challenging because of overlapping symptoms and the absence of sensitive diagnostic criteria for either condition. OBJECTIVE: To evaluate patients with concomitant clinical suspicion for inducible laryngeal obstruction and asthma. We used a multidisciplinary protocol incorporating objective diagnostic criteria to determine whether asthma, inducible laryngeal obstruction, both, or neither diagnosis was present...
June 5, 2018: Clinical and Experimental Allergy: Journal of the British Society for Allergy and Clinical Immunology
K Tuite, J C Oosthuizen, T Subramaniam, J B Kinsella
Laryngeal cancers are rare, encompassing around one percent of all cancers. Suspicion should be raised if a patient presents with classical signs and symptoms; i.e. dysphonia, inspiratory stridor, dysphagia, odynophagia, neck mass, or persistent cough. Laryngeal chondrosarcoma is a rare form of laryngeal cancer, the diagnosis of which can be difficult. The case in question describes an unusual presentation of one such case, and its subsequent investigation, management and outcome.
January 10, 2018: Irish Medical Journal
Anthony Ca Yii, Tunn-Ren Tay, Xue Ning Choo, Mariko Sy Koh, Augustine Kh Tee, De-Yun Wang
United airways disease (UAD) is the concept that the upper and lower airways, which are anatomically and immunologically related, form a single organ. According to this concept, upper and lower airway diseases are frequently comorbid because they reflect manifestations of a single underlying disease at different sites of the respiratory tract. Allergic asthma-allergic rhinitis is the archetypal UAD, but emerging data indicate that UAD is a heterogeneous condition and consists of multiple phenotypes (observable clinical characteristics) and endotypes (pathobiologic mechanisms)...
June 5, 2018: Allergy
Sandeep Jain, Peter J Kallio, Kenneth Less, Jutta Novalija, Paul S Pagel, Thomas J Ebert
Background: Nasal fiberoptic videoendoscopy is an established technique to assess upper airway pathology in conscious and sedated patients. Objectives: The authors conducted a prospective proof-of-concept pilot study to evaluate whether airway narrowing detected using nasal fiberoptic videoendoscopy in the anesthesia preoperative clinic was capable of defining the severity of obstructive sleep apnea (OSA) in patients scheduled for elective surgery. Methods: After application of topical local anesthesia (4% lidocaine with phenylephrine), sixteen patients (ASA physical status 2 or 3) underwent nasal fiberoptic videoendoscopy in sitting position...
February 2018: Anesthesiology and Pain Medicine
Valerie E Rogers, Mary E Bollinger, Mohan E Tulapurkar, Shijun Zhu, Jeffrey D Hasday, Kevin D Pereira, Steven M Scharf
OBJECTIVES: A bi-directional relationship exists between asthma and obstructive sleep apnea (OSA) in which presence of one is associated with increased prevalence and severity of the other. Our objective was to determine whether OSA accounted for differences in airway and systemic inflammation in asthmatic children and whether inflammation was associated with asthma control. We hypothesized that greater severity of SDB would correlate with increased upper airway and systemic inflammation and result in reduced asthma control...
June 3, 2018: Pediatric Pulmonology
Nobue Terabe, Soichiro Yamashita, Makoto Tanaka
We report unexpected exacerbation of tracheal stenosis during general anesthesia in a 50-year-old patient with Hunter syndrome undergoing cardiac surgery for valvular disease. He had undergone cervical laminoplasty 3 months previously; at that time, his airway had been uneventfully managed. Preoperative flexible fiberoptic laryngoscopy showed a normal upper respiratory tract, but chest computed tomography showed tracheal stenosis that had flattened the lumen. The narrowest part above the tracheal bifurcation was 2 cm long and the anteroposterior diameter was ≤6 mm...
2018: Case Reports in Anesthesiology
Ying Xuan Zhi, Daniel Vena, Milos R Popovic, T Douglas Bradley, Azadeh Yadollahi
BACKGROUND: Inspiratory flow limitation is a breathing pattern during sleep caused by upper airway (UA) narrowing that occurs during snoring and various degrees of obstructive sleep apnea (OSA). Clinical examination of flow limitation relies on identifying patterns of airflow contour, however this process is subjective and lacks physiological evidence of UA narrowing. Our objective is to derive the temporal features of nasal airflow contour that characterize flow limitation. The features that correlate with UA narrowing can be used to develop machine learning classifiers to detect flow limitation with physiological support...
May 2, 2018: Sleep Medicine
Luisa Maria Bellussi, Maria Pia Villa, Giulia Degiorgi, Francesco Maria Passali, Melania Evangelisti, Ilaria Innocenti Paganelli, Marilisa Montesano, Desiderio Passali
OBJECTIVES: The purpose of this prospective study was to assess the effectiveness and safety of Streptococcus salivarius 24SMBc administered as a nasal spray in children affected by recurring infections of the upper airways, adenotonsillar hypertrophy, and sleep disordered breathing (SDB). METHODS: Prospective study on 42 children with SDB. Anamnestic and general examination data were collected using the 'Sleep Clinical Record' (SCR) questionnaire during the first inspection and after three months of treatment with Streptococcus salivarius 24SMBc nasal spray...
July 2018: International Journal of Pediatric Otorhinolaryngology
Xiaopeng Guo, Lu Gao, Ya'nan Zhao, Man Wang, Bo Jiang, Qiang Wang, Zihao Wang, Xiaohai Liu, Ming Feng, Renzhi Wang, Zhuhua Zhang, Bing Xing
OBJECTIVE: To explore the radiological characteristics of the upper respiratory tract and their correlations with obstructive sleep apnoea/hypopnea syndrome (OSAHS) in patients with acromegaly. METHODS: Computed tomography (CT) and magnetic resonance imaging (MRI) were performed in untreated patients with acromegaly placed in straight (SHP) and extended head positions (EHP). Overnight polysomnography was performed to evaluate OSAHS, and the apnoea/hypopnea index (AHI) was measured...
May 9, 2018: Sleep Medicine
Ying Zou, Wei Wang, Xinshi Nie, Jian Kang
Obstructive sleep apnea (OSA) is characterized by the repetitive collapse of the upper airway and chronic intermittent hypoxia (CIH) during sleep. It has been reported that CIH can increase the EMG activity of genioglossus in rats, which may be related to the neuromuscular compensation of OSA patients. This study aimed to explore whether CIH could induce the long-term facilitation (LTF) of genioglossus corticomotor activity. 16 rats were divided into the air group ( n =8) and the CIH group ( n =8). The CIH group was exposed to hypoxia for 4 weeks; the air group was subjected to air under identical experimental conditions in parallel...
2018: Canadian Respiratory Journal: Journal of the Canadian Thoracic Society
Chantal Darquenne, Ann R Elliott, Bastien Sibille, Erik T Smales, Pamela N DeYoung, Rebecca J Theilmann, Atul Malhotra
We used magnetic resonance imaging (MRI) to quantify change in upper airway dimension during tidal breathing in subjects with obstructive sleep apnea (OSA, N = 7) and BMI-matched healthy controls (N = 7) during both wakefulness and natural sleep. Dynamic MR images of the upper airway were obtained on a 1.5 T MR scanner in contiguous 7.5 mm-thick axial slices from the hard palate to the epiglottis along with synchronous MRI-compatible electroencephalogram and nasal/oral flow measurements. The physiologic data were retrospectively scored to identify sleep state, and synchronized with dynamic MR images...
May 2018: Physiological Reports
Ambra Cesareo, Antonella LoMauro, Marika Santi, Emilia Biffi, Maria G D'Angelo, Andrea Aliverti
BACKGROUND: Duchenne muscular dystrophy (DMD) is characterized by progressive degeneration, wasting, and weakness of skeletal musculature, including respiratory muscles. Cough is also compromised with disease progression. Among cough-augmentation techniques, mechanical insufflation-exsufflation (MI-E) has demonstrated several clinical benefits in patients with chronic airway secretion obstruction and muscular weakness. In clinical practice, the use of MI-E in DMD patients is also suggested when they are stable with no airway infections...
May 29, 2018: Respiratory Care
Katrin Hasselbacher, B Hofauer, J T Maurer, C Heiser, A Steffen, J U Sommer
PURPOSE: Upper airway stimulation (UAS) is an alternative second-line treatment option for patients with obstructive sleep apnea (OSA). In our substudy of a previous multicentre study of patients implanted with UAS, we focused on patient-related outcomes like Epworth Sleepiness Scale (ESS), the Functional Outcomes of Sleep Questionnaire (FOSQ), snoring and personal satisfaction 6 and 12 months after the implantation. METHODS: 60 patients, who were initially non-adherent to CPAP and implanted with UAS, were included in a prospective multicentre study...
May 28, 2018: European Archives of Oto-rhino-laryngology
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