Sleep Apnea Syndromes: Stuck BA

Verse T, de la Chaux R, Dreher A, Fischer Y, Grundmann T, Hecksteden K, Hörmann K, Hohenhorst W, Ilgen F, Kühnel T, Mahl N, Maurer JT, Pirsig W, Roth B, Siegert R, Stuck BA, Anonymous00280. · Klinik für HNO-Heilkunde, Asklepios Klinik Harburg, Hamburg. · Laryngorhinootologie. · Pubmed #17464894 No free full text.

This publication has no abstract.

Maurer JT, Stuck BA. · Schlafmedizinisches Zentrum, Universitäts-Hals-Nasen-Ohren-Klinik Mannheim, Medizinische Fakultät Mannheim der Ruprecht-Karls-Universität Heidelberg, 68135 Mannheim, Deutschland. · HNO. · Pubmed #18853128 No free full text.

Abstract: During the past two decades, different methods of upper airway evaluation for patients with obstructive sleep apnea (OSA) have been investigated. Although clinical assessment is the basis of any diagnostic workflow in OSA, the Mueller maneuver is apparently of no importance. Imaging techniques have increased our knowledge of the pathophysiology of OSA. Cephalometry is done only if maxillomandibular advancement is planned; dynamic investigations such as computed tomography and magnetic resonance imaging are able to picture the pharyngeal collapse and have the capacity to simulate the effect of interventions on OSA severity. So far, video endoscopy under sedation can only predict the success of oral appliances. Multichannel pressure recordings depict the distribution of obstructive events in the upper or lower pharyngeal segment during the entire night. The impact of sophisticated upper airway evaluation remains limited compared with standard clinical assessment. Further research is needed to develop valuable tools for the diagnostic workup of patients with OSA.

Stuck BA, Maurer JT. · Department of Otorhinolaryngology, Head and Neck Surgery, Sleep Disorders Center, University Hospital Mannheim, 68135 Mannheim, Germany. · Sleep Med Rev. · Pubmed #18054259 No free full text.

Abstract: As the interest in sleep-disordered breathing has increased, various attempts have been made to assess upper airway anatomy in patients with this relatively frequent disorder. The aim is not only to reveal potential differences in upper airway anatomy to better understand origin and pathophysiology of the disease but also to improve patient management and treatment success. The present review is based on a systematic literature search with regard to upper airway evaluation in sleep-disordered breathing; the articles were selected and discussed in light of our clinical experiences. Based on clinical assessment including endoscopy during wakefulness, the value of the Mueller Maneuver, static radiologic imaging techniques (X-ray cephalometry, computed tomography (CT) scanning and magnetic resonance imaging (MRI)), dynamic scanning protocols (e.g. ultrafast CT or cine MRI), upper airway endoscopy during sleep and sedated sleep, pressure measurements and the assessment of the critical closing pressure are discussed. Each technique itself and its history in the field of sleep medicine are briefly reviewed and problems of standardization and interpretation are discussed when appropriate. Insights into the pathophysiology of the disease gained with the help of the investigational techniques are presented and the impact of the techniques on patient management is reported. Although all these additional techniques for upper airway assessment have substantially improved our understanding of sleep-disordered breathing, their significance in daily practice is limited. In contrast to the widespread use of the Mueller maneuver and sedated endoscopy, convincing data supporting their use in terms of treatment outcome are lacking. So far, there is only very limited evidence that selected techniques improve treatment outcome for selected indications. In general, there is not enough evidence that these techniques are superior to the routine clinical assessment.

Randerath W, Bauer M, Blau A, Fietze I, Galetke W, Hein H, Maurer JT, Orth M, Rasche K, Rühle KH, Sanner B, Stuck BA, Verse T, Anonymous00032. · Institut für Pneumologie, Universität Witten/Herdecke, Krankenhaus Bethanien, Klinik für Pneumologie und Allergologie, Zentrum für Schlaf- und Beatmungsmedizin, Solingen, Germany. · Pneumologie. · Pubmed #17538860 No free full text.

Abstract: Many patients with the obstructive sleep apnea syndrome (OSAS) look for alternative conservative or surgical therapies to avoid to be treated with continuous positive airway pressure. In view of the high prevalence and the relevant impairment of the patients lots of methods are offered which promise definitive cure or relevant improvement of OSAS. The working group "Apnea" in the German Society of Sleep Medicine and Research established a task force to evaluate the scientific literature on non-CPAP therapies in the treatment of OSAS according to the standards of evidence-based medicine. This paper summarizes the results of the task force. The data were unsatisfactorily for most of the methods. Sufficient data were available for intraoral appliances (IOA) and the maxillomandibular osteotomy (MMO). IOA's can reduce mild to moderate respiratory disturbances, MMO are efficient in the short and long term but are performed only in special situations such as craniofacial dysmorphias. Weight reduction and body positioning cannot be recommended as a single treatment of OSAS. Most surgical procedures still lack sufficient data according to the criteria of evidence based medicine. Resections of muscular tissue within the soft palate have to be strictly avoided. But even success following gentle soft palate procedures is difficult to predict and often decreases after years. Results in other anatomical regions seem to be more stable over time. Today combined surgeries in the sense of multi-level surgery concepts are of increasing interest in the secondary treatment after failure of nasal ventilation therapy although more data from prospective controlled studies are needed. There is no evidence for any other treatment options.

Stuck BA, Maurer JT, Verse T, Hein G, Schiffmann B, Hörmann K. · Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Mannheim. · Otolaryngol Pol. · Pubmed #15101284 No free full text.

Abstract: Snoring is a widespread disorder, mostly affecting middle-aged men. Snoring is not harmful in itself, but may lead to social impairment. Therefore, snorers often seek for medical advice and effective treatment. Sleep studies are mandatory especially when surgical procedures are intended. Due to the lack of reliable objective snoring analysis, the evaluation by the bed partners is the most relevant criteria in estimating treatment success. Body weight and behaviour patterns are crucial in the treatment of snoring. Furthermore, oral appliances and other implements may be beneficial. Various kinds of surgical procedures are available, soft palate techniques being the most widespread. Minimally invasive procedures are safe and effective in the majority of patients. Temperature controlled radiofrequency tissue ablation offers much potential in the treatment of primary snoring. Furthermore, a system is currently being developed which is supposed to stabilise the soft palate with the help of implants.

Verse T, Pirsig W, Stuck BA, Hörmann K, Maurer JT. · Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Mannheim, Germany. · Am J Respir Med. · Pubmed #14720014 No free full text.

Abstract: Modern sleep medicine has been in existence for only 20 years and therefore has to be regarded as a comparatively recent field of specialization. For this reason it is not surprising that there are numerous new trends and developments concerning the treatment of sleep-related breathing disorders. This review focuses on developments in the treatment of obstructive sleep apnea (OSA) over the last 5 years.The review is based on a Medline bibliographic search using the key words 'treatment', 'obstructive sleep apnea' and 'sleep-related breathing disorders' and covers papers published since 1997, including references in these articles. In respect to conservative treatments the following important developments were found. Oral devices were shown to be effective in about 50-70% of patients with OSA, but at this stage it is not possible to predict in which patients successful treatment can be expected. As subjective compliance averages only about 50%, thermoplastic devices used as trial devices provide a reasonable alternative to reduce costs. Automatic continuous positive airway pressure (CPAP) units have been shown to cut costs when used for pressure titration in severe sleep apneics during the day or when used in so-called split-night procedures in appropriate cases. Nasal CPAP has proven to be effective in children, showing higher compliance rates than in adults. The development of mouth-pieces provides the possibility of using CPAP orally, e.g. after nasal surgery. Electrical stimulation of the tongue muscles shows promising preliminary results. Nevertheless, further research in this field is necessary.In the field of surgery, the most valuable development has been tissue reduction using radiofrequency energy, which has been shown to be effective and minimally invasive. Other fundamentally new surgical techniques have not been attempted within the last 5 years; instead, development in this area appears to be defined by a combination of previously known methods (so-called multilevel surgery) and optimized methods of patient selection. Such combined surgical procedures has achieved success rates of about 70%.Taking all these developments into account, CPAP therapy remains the gold standard for treatment of patients with OSA; yet the low long-term compliance rates of 60-70% have to be regarded as a major challenge warranting further effort.

Hamans E, Boudewyns A, Stuck BA, Baisch A, Willemen M, Verbraecken J, Van de Heyning P. · Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Antwerp, Antwerp, Belgium. · Ann Otol Rhinol Laryngol. · Pubmed #19102126 No free full text.

Abstract: OBJECTIVES: Surgical treatment of obstructive sleep apnea (OSA) caused by hypopharyngeal collapse of the upper airway can be considered in patients who are intolerant to continuous positive airway pressure (CPAP). The present procedures addressing the hypopharynx are invasive and have substantial morbidity and limited efficacy. METHODS: Ten patients (mean age, 44 years) with moderate to severe OSA, ie, an apnea-hypopnea index (AHI) between 15 and 50, with CPAP intolerance were included in a prospective, nonrandomized, multicenter study to evaluate the feasibility, safety, and efficacy of a novel tongue advancement procedure. The procedure consists of the implantation of a tissue anchor in the tongue base and an adjustment spool at the mandible. Titration of this tissue anchor results in advancement of the tongue and a patent upper airway. RESULTS: The mean AHI decreased from 22.8 at baseline to 11.8 at the 6-month follow-up (p = 0.007). The Epworth Sleepiness Scale score decreased from 11.4 at baseline to 7.7 at the 6-month follow-up (p = 0.094), and the snoring score decreased from 7.5 at baseline to 3.9 at the 6-month follow-up (p = 0.005). Four technical adverse events were noted, and 1 clinical adverse event occurred. CONCLUSIONS: Adjustable tongue advancement is a feasible and relatively safe way to reduce the AHI and snoring in selected patients with moderate to severe OSA and CPAP intolerance. Technical improvements and refinements to the procedure are ongoing.

Baisch A, Hein G, Gössler U, Stuck BA, Maurer JT, Hörmann K. · Universitäts-HNO-Klinik Mannheim. · HNO. · Pubmed #16132876 No free full text.

Abstract: INTRODUCTION: Previous results showed the high effectiveness of our multi-level surgery concept based on the modified hyoid suspension for obstructive sleep apnea (OSA). This study was aimed at evaluating the discomforts and side-effects of this surgical concept. METHODS: Between November 2001 and June 2004, 102 patients with OSA and/or with laryngeal stenosis, who were all treated with a hyoid suspension in combination with surgery at the base of tongue, the soft palate or the nose, were included in the study. A questionnaire on discomfort and snoring was given to the patients. They were asked to answer the questions at the earliest 1 month after surgery. A reduction in snoring to a level which was tolerated by the bed-partner was regarded as success. RESULTS: Half of the patients needed analgesics until the 14th day after surgery, complained dysphagia until day 20 and had problems with their speech until day 30. However, 84% indicated that they would undergo surgery again; 94% reported a successful reduction in their snoring. CONCLUSION: Nearly all of the patients tolerated the discomforts and side-effects of our multi-level surgical concept. In combination with a reduction in snoring in 94% of all cases, this surgical concept was considered favorably by the patients.

Stuck BA, Köpke J, Hörmann K, Verse T, Eckert A, Bran G, Düber C, Maurer JT. · Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Mannheim, Germany. · Otolaryngol Head Neck Surg. · Pubmed #15632924 No free full text.

Abstract: OBJECTIVES: Radiofrequency surgery is a minimally invasive technique for the treatment of the tongue base in sleep-disordered breathing. The aim of this study was to evaluate the changes in upper airway anatomy induced by radiofrequency surgery with MRI. STUDY DESIGN AND SETTING: 10 patients with sleep-disordered breathing were treated with radiofrequency surgery at tongue base. MRI measurements were performed before and after surgery with the help of a recently published protocol. RESULTS: The mean total number of energy delivered per patient was 4750 +/- 1641 Joule. Relevant changes could be observed neither for tongue volume or dimension nor for retrolingual space. CONCLUSIONS: Changes in upper airway anatomy could not be demonstrated. The effects of radiofrequency surgery of the tongue base may more likely be a result of changes in upper airway collapsibility. SIGNIFICANCE: Functional effects of surgical interventions in sleep-disordered breathing should be considered in addition to mechanistic concepts alone.

Stuck BA, Starzak K, Hein G, Verse T, Hörmann K, Maurer JT. · Department of Otorhinolaryngology--Head and Neck Surgery, Sleep Disorders Center, University Hospital Mannheim, Mannheim, Germany. · Acta Otolaryngol. · Pubmed #15370568 No free full text.

Abstract: OBJECTIVE: To investigate the safety and efficacy of combined temperature-controlled radiofrequency volumetric tissue reduction of the tongue base and soft palate in obstructive sleep apnoea. MATERIAL AND METHODS: A total of 20 patients with obstructive sleep apnoea and combined palatal and retrolingual obstruction were included in a non-randomized clinical trial and 51 combined treatments were performed under local anaesthesia. Postoperative pain was assessed using visual analogue scales. Functional parameters, daytime sleepiness and quality of life were assessed using questionnaires (Epworth Sleepiness Scale, Short Form-36) before and 12 weeks after the last treatment session. Concurrently, polysomnography was performed on two consecutive nights. Results The mean postoperative pain score dropped from 5.6 at Day 1 to 0.6 at Day 7. Painkillers were taken for a mean of 3.3 days. There were no postoperative complications or changes in functional parameters. Daytime sleepiness improved significantly (p<0.05). The mean respiratory disturbance index was reduced from 25.3+/-11.4 to 16.7+/-15.3 (p<0.05). Six out of 18 (33%) patients were cured after a mean of 2.7 treatment sessions. CONCLUSION: Combined radiofrequency volumetric tissue reduction of the tongue base and soft palate is a safe and effective treatment for obstructive sleep apnoea.

Stuck BA, Köpke J, Maurer JT, Verse T, Eckert A, Düber C, Hörmann K. · Universitäts-HNO-Klinik Mannheim. · HNO. · Pubmed #12955249 No free full text.

Abstract: BACKGROUND: Due to its minimally invasive character, radiofrequency surgery has become a topic of increasing attention, especially with respect to the surgical treatment of sleep-related breathing disorders. Temperature-controlled radiofrequency volumetric tissue reduction is the most common technique employed in these cases. However, despite the increasingly widespread use of this technique, there is little data available on the induced effects in vivo. The aim of the present study was to investigate whether magnetic resonance imaging could be used in the evaluation of the in vivo effects of radiofrequency surgery at the base of the tongue. PATIENTS AND METHODS: Six patients were treated at the base of tongue with radiofrequency surgery. At 4-6, 8-10 and 24 h after surgery, magnetic resonance imaging was performed using an inversion recovery technique (TIRM) and the lesions created were evaluated. RESULTS: The lesions could be visualised at all postoperative measurement times. They appeared as oval hypointense structures encircled by a hyperintense area. Lesion size diminished slightly over time. DISCUSSION: Lesions induced by radiofrequency surgery can be clearly visualised with magnetic resonance imaging. Lesion size may be assessed in relation to energy application. In the future, the treatment of sleep-related breathing disorders may be further optimised with the help of this technique.

Goessler UR, Hein G, Verse T, Stuck BA, Hormann K, Maurer JT. · Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Mannheim, Theodor-Kutzer-Ufer, D-68135 Mannheim, Germany. · Acta Otolaryngol. · Pubmed #17453480 No free full text.

Abstract: CONCLUSION: The palatal implant method originally designed to reduce snoring can significantly reduce the apnea-hypopnea index (AHI) in some patients with mild to moderate obstructive sleep apnea (OSA) in a single office-based procedure. OBJECTIVE: An initial study designed to evaluate the short-term efficacy and safety of palatal implants as primary treatment for patients with mild to moderate OSA. MATERIALS AND METHODS: This was a prospective, non-randomized study of 16 previously untreated and undiagnosed patients with sleep apnea. The inclusion criteria were an AHI of 10-30/h and a body mass index (BMI) < or = 30. RESULTS: The mean AHI was reduced following implantation, from 16.1 to 11.8 (p<0.01). A reduction in AHI was achieved in 13 patients (81%). Ten of 16 patients had their AHI reduced to <10.0. Snoring intensity decreased from 8.3+/-1.8 to 4.7+/-2.5 on a visual analog scale (p<0.001) and daytime sleepiness dropped from 7.2+/-2.5 to 4.6+/-3.2 on the Epworth Sleepiness Scale (p<0.05). No significant adverse events were reported.

Verse T, Baisch A, Maurer JT, Stuck BA, Hörmann K. · Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Mannheim, Mannheim, Germany. · Otolaryngol Head Neck Surg. · Pubmed #16564374 No free full text.

Abstract: OBJECTIVE: To determine the efficacy of a new multilevel surgical protocol for obstructive sleep apnea (OSA). STUDY DESIGN AND SETTING: Sixty patients with moderate to severe OSA because of multilevel pharyngeal obstruction were enrolled into this prospective, controlled clinical trial after clinical examination, endoscopy, and polysomnography. Surgery included uvulaflap, tonsillectomy, hyoid suspension, and radiofrequency treatment of the tongue base (group A). A second group did not receive hyoid suspension (group B). In both groups, nasal surgery was performed if necessary. Polysomnography and Epworth Sleepines Scale (ESS) were recorded at baseline and 2 to 15 months after surgery. RESULTS: In group A, the mean apnea-hypopnea index (AHI) decreased significantly after surgery (38.9 +/- 20.0 vs 20.7 +/- 20.6, P < 0.0001), whereas in group B the AHI did not. All secondary variables (minimal oxygen saturation, mean oxygen saturation, arousal index), and the ESS significantly improved in group A with only changes in arousal index and ESS reaching levels of significance in group B. CONCLUSION: The presented protocol including the hyoid suspension proved to be effective in the treatment of OSA, whereas surgery without hyoid suspension was less successful. EBM rating: B-2b.

Stuck BA, Neff W, Hörmann K, Verse T, Bran G, Baisch A, Düber C, Maurer JT. · Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Germany. · Otolaryngol Head Neck Surg. · Pubmed #16143189 No free full text.

Abstract: OBJECTIVE: To assess the effects of isolated hyoid suspension on subjective and objective parameters of obstructive sleep apnea and to evaluate changes in upper airway anatomy with the help of standardized magnetic resonance imaging. STUDY DESIGN AND SETTING: Fifteen patients received isolated hyoid suspension. Changes in respiratory disturbance index were assessed with polysomnography, and anatomical changes with standardized magnetic resonance imaging. Snoring, daytime sleepiness, and functional parameters were assessed with questionnaires. Lateral x-ray cephalometry was performed preoperatively. RESULTS: Mean respiratory disturbance index was reduced from 35.2 +/- 19.1 to 27.4 +/- 26.2. Forty percent of the patients were classified as responders. Daytime sleepiness improved significantly. Relevant changes in upper airway anatomy could not be detected. There were no remarkable differences between responders and nonresponders in regard to imaging. CONCLUSIONS: Hyoid suspension is effective only in a subgroup of patients and does not lead to relevant changes in airway diameters in the awake patient. Magnetic resonance imaging and x-ray cephalometry do not add additional information for patient selection. SIGNIFICANCE: The reported clinical effects of hyoid suspension are more likely due to functional changes in airway collapsibility than to an enlargement of the upper airway.

Verse T, Schwalb J, Hörmann K, Stuck BA, Maurer JT. · Universitäts-Hals-Nasen-Ohren-Klinik Mannheim, Mannheim. · HNO. · Pubmed #14647925 No free full text.

Abstract: BACKGROUND: Transcutaneous electrical stimulation while asleep has been used to treat obstructive sleep apnea (OSA), although without convincing results. Modern strategies consist of electrical muscle training for a number of weeks during wakefulness rather than stimulation during sleep. OBJECTIVE: The purpose of this study was to assess the practicability, safety, and efficacy of a new device, SilentOne (Imperpuls, Chemnitz, Germany). PATIENTS AND METHODS: Fifteen patients with various degrees of OSA used transcutaneous submental electrical stimulation therapy for 4-5 weeks every day, day and night. A patient's diary recorded practicability and potential adverse events. Respiratory parameters were recorded by fully attended polysomnography in the sleep lab. Daytime sleepiness and snoring were assessed by questionnaires. RESULTS: The apnea-hypopnea-index decreased from 29.2 before to 21.2 after therapy (P<0.05). Daytime sleepiness improved significantly (P<0.01) as did snoring (P<0.005). CONCLUSIONS. Transcutaneous electrical stimulation therapy using SilentOne proved to be safe, easy to use, and potent. However, therapy showed a limited cure rate.

Stuck BA, Köpke J, Maurer JT, Verse T, Eckert A, Bran G, Düber C, Hörmann K. · Department of Otolaryngology, Head and Neck Surgery, University Hospital Mannheim, Germany. · Laryngoscope. · Pubmed #12972936 No free full text.

Abstract: OBJECTIVES: Temperature controlled radiofrequency volumetric tissue reduction (RFVTR) of the tongue base is a minimally invasive technique for the treatment of obstructive sleep apnea. But despite its widespread use, little is yet known about in vivo effects in humans. Such knowledge would be essential for evidence-based criteria in the selection of energy application. METHODS: In a preparatory in vitro study, porcine tongues were preserved in growing medium. Lesions with different amounts of energy were applied, and maximum diameters were assessed. In the in vivo study, 11 patients were treated with RFVTR at the tongue base by employing different energy levels (800, 600, 400, or 200 J) on two application sites. Magnetic resonance imagery scans were performed 4 to 6, 8 to 10, and 24 hours after surgery. An inversion recovery technique was used to visualize the lesions. RESULTS: RFVTR created lesions at the porcine tongue from 50 J and higher. Maximum lesion sizes were achieved with 400 J. In vivo, all the lesions were clearly visible in the postoperative scans. Lesion size increased with the amount of energy applied. Maximum diameters were created from 600 J and higher. Higher amounts of energy only resulted in a slight increase in lesion length. CONCLUSIONS: The application of 600 J at 85 degrees C leads to optimal lesion sizes. Higher amounts of energy will not lead to a relevant increase in tissue necrosis. With regard to the time needed for application, 600 J appears to be the ideal adjustment for energy delivery in the treatment of the human tongue.

Stuck BA, Starzak K, Verse T, Hörmann K, Maurer JT. · Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Mannheim, Germany. · Acta Otolaryngol. · Pubmed #12797590 No free full text.

Abstract: OBJECTIVE: Temperature-controlled radiofrequency volumetric tissue reduction (RFVTR) is a minimally invasive technique used in the treatment of the tongue base, soft palate and turbinates. Complications seem to be rare, but the scope of previous studies was often limited by the small number of patients included. The aim of this study was to evaluate postoperative complications in a large series of patients. MATERIAL AND METHODS: In this retrospective study, temperature-controlled radiofrequency procedures (Somnoplasty) performed between May 1998 and March 2002 were considered. The charts of the patients were analyzed with regard to intra- or postoperative complications. RESULTS: In total, 322 patients received 497 treatment sessions; 239 of these treatments were isolated and the remaining 258 were combined procedures. Mean follow-up was 122.8 +/- 145.5 days. Concerning radiofrequency surgery, nine postoperative complications were observed (2.0%) as follows: ulcerations of the tongue base or soft palate; dysphagia necessitating hospital admission; temporary palsy of the hypoglossal nerve; and an abscess of the base of the tongue. CONCLUSIONS: Complications occurring after RFVTR are infrequent and mostly mild. Overall, temperature-controlled RFVTR is a safe procedure when used both in isolation and as part of a combined approach.

Maurer JT, Stuck BA, Hein G, Verse T, Hörmann K. · Schlafmedizinisches Zentrum, Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde, Mannheim. · Dtsch Med Wochenschr. · Pubmed #12529835 No free full text.

Abstract: BACKGROUND AND OBJECTIVE: Prevention of the supine position has for decades been a well known treatment option in positional obstructive sleep apnea. It was the aim of this study to test the efficacy of a recently patented commercially available supine position preventing vest. PATIENTS AND METHODS: The vest is made of linen tissue with a half cylindrical piece of hard foam in its dorsal part. 12 male patients slightly overweight (body mass index 26.5 +/- 2.6 kg/m(2)) and 55.8 +/- 11.6 years old were investigated polysomnographically prospectively. RESULTS: The pretherapeutical respiratory-disturbance index (RDI) was 26.7+/-11.9/h increasing to 39.3+/-16.1/h in the supine position. When using the vest, patients no longer slept on their back and the RDI dropped to 7.6 +/- 5.1/h (p < 0.005). Total sleep time at an oxygen saturation below 90 % was reduced from 11.7 +/- 11.3 % to 1.5 +/- 2.1 %. 9 patients (75 %) were cured (RDI < 10/h and RDI reduction > 50 %), 2 patients (17 %) improved (RDI reduction > 50 %) and only the oldest patient (76 years old) remained unchanged. Even though snoring decreased from 180 +/- 125 minutes to 110 +/- 52 minutes, an increase was observed in 30 % of the patients. Sleep quality and structure did not change considerably. CONCLUSION: The supine position prevention vest is a safe and simple treatment alternative of high efficacy in positional sleep apnea. As a complete remission cannot be predicted, polygraphic or polysomnographic controls are necessary.

Stuck BA, Maurer JT, Verse T, Hörmann K. · Sleep Disorders Center, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Germany. · Acta Otolaryngol. · Pubmed #12206264 No free full text.

Abstract: In recent years a considerable effort has been made to establish the use of different surgical techniques for the treatment of obstructive sleep apnea syndrome (OSAS). Nevertheless, treatment of hypopharyngeal obstruction due to tongue base hypertrophy remains in many ways an unsolved problem. The aim of this study was to evaluate the safety and efficacy of tongue base reduction with temperature-controlled radiofrequency volumetric tissue reduction in the treatment of OSAS. Twenty patients with OSAS and tongue base hypertrophy were treated with radiofrequency tissue ablation. An intensified treatment protocol was used, delivering 2,800 J per treatment session under local anesthesia. Two nights of polysomnography testing were performed before and after treatment. Daytime sleepiness, snoring and postoperative morbidity were assessed using questionnaires. Mean respiratory disturbance index (RDI) was reduced from 32.1 to 24.9/h after a mean of 3.4 treatment sessions. Six patients (33%) were cured after the procedure (reduction in RDI of > or = 50% and a postoperative RDI of < 15/h) and ten (55%) showed an improvement of > 20% in their RDI. Daytime sleepiness and snoring improved significantly. Peri- and postoperative morbidity was low; one severe complication occurred (tongue base abscess). We were able to achieve similar cure and responder rates to those reported in a recently published pilot study but with a reduced number of treatment sessions. We believe that this technique may improve patient acceptance and have beneficial cost implications.

Stuck BA, Maurer JT, Hörmann K. · Universitäts-Hals-Nasen-Ohrenklinik, Klinikum Mannheim, 68135 Mannheim. · HNO. · Pubmed #11486586 No free full text.

Abstract: BACKGROUND AND OBJECTIVE: Tongue base reduction with temperature-controlled radiofrequency for the treatment of obstructive sleep apnea syndrome is a minimally invasive technique. Repeated application leads to a progressive shrinking of the tissue. PATIENTS AND METHODS: In our study, we summarize the experiences gained from 100 tongue base reductions and compare them with the pilot study that was recently published. An intensified treatment scheme was used with higher amounts of energy applied per treatment session. Visual analogue scales were used for the assessment of postoperative pain and functional parameters. Regular follow-up visits were scheduled to evaluate postoperative complications. RESULTS: Postoperative pain was mostly mild or moderate. Paraoperative complications were not observed. The overall rate for postoperative complications was 8%, with 2% mild and 5% moderate complications. One severe complication--a tongue base abscedation--was observed. Using para- and postoperative antibiotic prophylaxis reduced the rate of complications. Functional parameters such as taste or swallowing were not affected. CONCLUSIONS: Our results underline the safety of the procedure and demonstrate the minimal para- and postoperative morbidity. The increased amount of energy applied per session has not led to an increase in postoperative morbidity.

Stuck BA, Maurer JT, Verse T, Hormann K. · No affiliation provided · Otolaryngol Head Neck Surg. · Pubmed #12087342 No free full text.

This publication has no abstract.