Snoring and All-Cause Mortality: Does an Association Exist?
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77%, Zone 3 injuries in 5%, combined Zone 1-2 injuries in 5%, and combined Zone 2-3 injuries in 3% of patients. The positive exploration rate (patients with positive intraoperative findings during exploration) was 73% (82/112). The mortality of patients undergoing neck exploration for primarily high- velocity penetrating neck trauma was 4.6%. CONCLUSION: The perioperative mortality and the positive exploration rate for high-velocity penetrating neck trauma by deployed surgeons in OIF are very comparable to those rates seen in civilian centers that manage low-velocity penetrating neck trauma. Our data supports a Selective neck exploration algorithm for both wartime high-velocity and civilian low- velocity penetrating neck trauma. Pharyngeal Upper Airway (phUAW) Structural Assessment in OSA B Tucker Woodson, MD (presenter) OBJECTIVE: A new methodology of phUAW structural as- sessment is proposed as an alternative to methods which inad- equately describe, guide or predict reconstructive surgery for OSA. Study objectives are: 1) Describe structural assessment, and 2) Compare evaluation outcomes. METHOD: A cohort of 117 patients (81% male, age 51.4 years, AHI 38.5 events/hr) underwent a standardized continu- ous infusion propofol sedated endoscopy and phUAW assess- ment based on 8 key anatomic landmarks that define elemental structure, including hard palate, palatal aponeurosis, genu, ve- lum, and lateral wall, lingual tonsils, dorsal and vallecular tongue base, and epiglottis. Findings were compared to Fujita classification and categorized into structural subtypes. RESULTS: Level of obstruction (Fujita upper, combined, and lower pharynx) were 12%, 83%, and 5%, respectively. In contrast, structural assessment identified three palatal subtypes (oblique (52%), intermediate (23%), vertical (25%)). Lateral wall obstruction (7%) and major collapse (28%) were associ- ated almost exclusively with the oblique and intermediate vs vertical subtypes (51%, 44%, 10%, respectively, p0.05) with lateral wall hypertrophy associated with body mass index (p 0.05). CONCLUSION: Structural phUAW assessment identifies multiple airway subtypes unidentified with traditional scoring methods. Subtypes are unrelated to AHI but may be related to body mass index. Subtypes are proposed to guide surgical decision making and predict outcomes. Robotic OSAHS Surgery: Do the Ends Justify the Means? Claudio Vicini, MD (presenter); Filippo Montevecchi, MD; Giulia Tenti; Pietro Canzi, MD OBJECTIVE: Understand the feasibility, safety, efficacy of a robotic approach (DaVinci Platform) to tongue base surgery in OSAHS patients. METHOD: Retrospective study on 40 severe OSAHS adult patients surgically treated by means DaVinci Robotic Platform (tongue base reduction and supraglottoplasty) during the last 18 months in a tertiary care center. RESULTS: After 5.5 months post-op apnea Hypopnea Index changed from 35.9(/-21.0) to 13.3 (/-13.1) P 0.025 (Wilcoxon test); lowest oxygen saturation changed from 76.9 (/-9.5) to 82.8 (/-5.3) P 0.5 (T test); epworth sleepiness scale changed from 12.6 (/-4.5) to 7.6 (/-3.7) P 0.09 (T test); satisfaction rate was 95.0% (/-15.0). CONCLUSION: OSAHS TORS proved to be a feasible safe and effective surgical approach to OSAHS. Snoring and All-Cause Mortality: Does an Association Exist? Jeremy Rich, MD (presenter); Ayelette Raviv; Nataly Raviv OBJECTIVE: Snoring is a common problem that is often associated with Obstructive Sleep Apnea Syndrome (OSAS). However, it has been suggested that snoring may be harmful itself. Patients with objective snoring were matched against a mortality database and associations were explored. METHOD: Over 77,000 patients who underwent a portable sleep study (SNAP Test, SNAP Labs Inc, Wheeling, Illinois, USA) that includes a detailed, acoustical snoring analysis were matched to the Social Security Death File to establish mortality (1,653 deaths matched). Snoring indices to include amount (snoring events/hour), volume (dB), and palatal snoring versus nonpalatal snoring were correlated to all cause mortality using stepwise multivariate logistic regression. RESULTS: As expected, increasing age (OR1.84, 95% CI1.76-1.93, p0.001), BMI (OR1.23, 95%CI1.18- 1.28, p0.001), and male sex (OR1.38, 95%CI1.22-1.56, p0.001) were associated with all cause mortality. For all patients (with and without OSAS, n67,722 with complete data), increasing snoring events/hour (adjusted OR0.925, 95%CI0.890-0.962, p0.001) and increasing snoring loud- ness (decibels) (adjusted OR0.860, 95%CI0.803-0.922, p0.001) were associated with a modest decrease in observed mortality. Conversely, increasing nonpalatal snoring was asso- ciated with an increase in observed mortality (OR1.21, 95%CI1.09-1.35, p0.001). For patients without OSAS (AHI5) and with a BMI30 (n5955), increasing snoring events/hr was associated with a modest age, sex adjusted in- crease in mortality (OR 1.16, 95%CI1.01-1.32, p0.034). CONCLUSION: Nonpalatal snoring is associated with an increase in observed all cause mortality controlling for age, sex, BMI, and Apnea/Hypopnea Index whereas increasing palatal snoring was associated with a decrease in mortality. In patients without OSAS and a normal BMI, increasing snoring was associated a modest increase in all cause mortality. P52 Otolaryngology-Head and Neck Surgery, Vol 143, No 2S2, August 2010
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Transcript of Snoring and All-Cause Mortality: Does an Association Exist?
77%, Zone 3 injuries in 5%, combined Zone 1-2 injuries in5%, and combined Zone 2-3 injuries in 3% of patients. Thepositive exploration rate (patients with positive intraoperativefindings during exploration) was 73% (82/112). The mortalityof patients undergoing neck exploration for primarily high-velocity penetrating neck trauma was 4.6%.CONCLUSION: The perioperative mortality and the positiveexploration rate for high-velocity penetrating neck trauma bydeployed surgeons in OIF are very comparable to those ratesseen in civilian centers that manage low-velocity penetratingneck trauma. Our data supports a Selective neck explorationalgorithm for both wartime high-velocity and civilian low-velocity penetrating neck trauma.
Pharyngeal Upper Airway (phUAW) Structural
Assessment in OSA
B Tucker Woodson, MD (presenter)
OBJECTIVE: A new methodology of phUAW structural as-sessment is proposed as an alternative to methods which inad-equately describe, guide or predict reconstructive surgery forOSA. Study objectives are: 1) Describe structural assessment,and 2) Compare evaluation outcomes.METHOD: A cohort of 117 patients (81% male, age 51.4years, AHI 38.5 events/hr) underwent a standardized continu-ous infusion propofol sedated endoscopy and phUAW assess-ment based on 8 key anatomic landmarks that define elementalstructure, including hard palate, palatal aponeurosis, genu, ve-lum, and lateral wall, lingual tonsils, dorsal and valleculartongue base, and epiglottis. Findings were compared to Fujitaclassification and categorized into structural subtypes.RESULTS: Level of obstruction (Fujita upper, combined, andlower pharynx) were 12%, 83%, and 5%, respectively. Incontrast, structural assessment identified three palatal subtypes(oblique (52%), intermediate (23%), vertical (25%)). Lateralwall obstruction (7%) and major collapse (28%) were associ-ated almost exclusively with the oblique and intermediate vsvertical subtypes (51%, 44%, 10%, respectively, p0.05) withlateral wall hypertrophy associated with body mass index (p �0.05).CONCLUSION: Structural phUAW assessment identifiesmultiple airway subtypes unidentified with traditional scoringmethods. Subtypes are unrelated to AHI but may be related tobody mass index. Subtypes are proposed to guide surgicaldecision making and predict outcomes.
Robotic OSAHS Surgery: Do the Ends Justify the
Means?
Claudio Vicini, MD (presenter); Filippo Montevecchi,MD; Giulia Tenti; Pietro Canzi, MD
OBJECTIVE: Understand the feasibility, safety, efficacy of arobotic approach (DaVinci Platform) to tongue base surgery inOSAHS patients.
METHOD: Retrospective study on 40 severe OSAHS adultpatients surgically treated by means DaVinci Robotic Platform(tongue base reduction and supraglottoplasty) during the last18 months in a tertiary care center.RESULTS: After 5.5 months post-op apnea Hypopnea Indexchanged from 35.9(�/-21.0) to 13.3 (�/-13.1) P � 0.025(Wilcoxon test); lowest oxygen saturation changed from 76.9(�/-9.5) to 82.8 (�/-5.3) P � 0.5 (T test); epworth sleepinessscale changed from 12.6 (�/-4.5) to 7.6 (�/-3.7) P � 0.09 (Ttest); satisfaction rate was 95.0% (�/-15.0).CONCLUSION: OSAHS TORS proved to be a feasible safeand effective surgical approach to OSAHS.
Snoring and All-Cause Mortality: Does an
Association Exist?
Jeremy Rich, MD (presenter); Ayelette Raviv; NatalyRaviv
OBJECTIVE: Snoring is a common problem that is oftenassociated with Obstructive Sleep Apnea Syndrome (OSAS).However, it has been suggested that snoring may be harmfulitself. Patients with objective snoring were matched against amortality database and associations were explored.METHOD: Over 77,000 patients who underwent a portablesleep study (SNAP Test, SNAP Labs Inc, Wheeling, Illinois,USA) that includes a detailed, acoustical snoring analysis werematched to the Social Security Death File to establish mortality(1,653 deaths matched). Snoring indices to include amount(snoring events/hour), volume (dB), and palatal snoring versusnonpalatal snoring were correlated to all cause mortality usingstepwise multivariate logistic regression.RESULTS: As expected, increasing age (OR�1.84, 95%CI�1.76-1.93, p�0.001), BMI (OR�1.23, 95%CI�1.18-1.28, p�0.001), and male sex (OR�1.38, 95%CI�1.22-1.56,p�0.001) were associated with all cause mortality. For allpatients (with and without OSAS, n�67,722 with completedata), increasing snoring events/hour (adjusted OR�0.925,95%CI�0.890-0.962, p�0.001) and increasing snoring loud-ness (decibels) (adjusted OR�0.860, 95%CI�0.803-0.922,p�0.001) were associated with a modest decrease in observedmortality. Conversely, increasing nonpalatal snoring was asso-ciated with an increase in observed mortality (OR�1.21,95%CI�1.09-1.35, p�0.001). For patients without OSAS(AHI�5) and with a BMI�30 (n�5955), increasing snoringevents/hr was associated with a modest age, sex adjusted in-crease in mortality (OR� 1.16, 95%CI�1.01-1.32, p�0.034).CONCLUSION: Nonpalatal snoring is associated with anincrease in observed all cause mortality controlling for age,sex, BMI, and Apnea/Hypopnea Index whereas increasingpalatal snoring was associated with a decrease in mortality. Inpatients without OSAS and a normal BMI, increasing snoringwas associated a modest increase in all cause mortality.
P52 Otolaryngology-Head and Neck Surgery, Vol 143, No 2S2, August 2010
