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Biomedical subjects

A E Sher

Publications and source records attributed to A E Sher.

13 recordsLinked to original sources
PubMed1996

The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome.

This paper, which has been reviewed and approved by the Board of Directors of the American Sleep Disorders Association, provides the background for the Standards of Practice Committee's parameters for the practice of sleep medicine in North America. The intent of this paper is to provide an overview of the surgical treatment of obstructive sleep apnea syndrome, to provide the basis for the American Sleep Disorders Association's practice parameters on this subject and to share our findings of metanalysis of previously published studies regarding uvulopalatopharyngoplasty. We searched MEDLINE from January 1966 through April 1993, with an update in February 1995, to provide a review of the application of surgical modifications of the upper airway to treat adults with obstructive sleep apnea syndrome. Operations to treat obstructive sleep apnea syndrome include nasal septal reconstruction; uvulopalatopharyngoplasty; uvulopalatopharyngoglossoplasty; laser midline glossectomy; lingualplasty; inferior sagittal mandibular osteotomy and genioglossal advancement, with hyoid myotomy and suspension (the entire process is referred to as GAHM); maxillomandibular osteotomy and advancement, and tracheotomy. Papers included in metanalysis provided preoperative and postoperative polysomnographic data on at least nine patients treated with uvulopalatopharyngoplasty for their obstructive sleep apnea. Analysis of the uvulopalatopharyngoplasty papers revealed that this procedure is, at best, effective in treating less than 50% of patients with obstructive sleep apnea syndrome. The site of pharyngeal narrowing or collapse, although identified by different and unvalidated methods, has a marked effect on the probability of success of uvulopalatopharyngoplasty. Patients who achieve a favorable response with uvulopalatopharyngoplasty tend to have less severe obstructive sleep apnea than those who do not. For patients who demonstrate retrolingual narrowing or collapse, other surgical modifications have been described, such as lingualplasty, GAHM, and maxillomandibular osteotomy and advancement. The studies to support the use of the surgical treatment of obstructive sleep apnea syndrome contain biases related to small sample size, limited follow-up and patient selection.

Adult↗
PubMed1995

Methodological and statistical problems in sleep apnea research: the literature on uvulopalatopharyngoplasty.

A comprehensive review of the literature on the surgical treatment of sleep apnea found 37 appropriate papers (total n = 992) on uvulopalatopharyngoplasty (UPPP). Methodological and statistical problems in these papers included the following: 1) There were no randomized studies and few (n = 4) with control groups. 2) Median sample size was only 21.5; thus statistical power was low and clinically important associations were routinely classified as "not statistically significant". 3) Only one paper presented the confidence bounds that might distinguish between statistical and clinical significance. 4) Because of short follow-up time and infrequent repeat follow-ups, little is known about whether UPPP results deteriorate with time. 5) In at least 15 papers, bias caused by retrospective designs and nonrandom loss to follow-up raised questions about the generalizability of results. 6) Few papers associated polysomnographic data with patient-based quality of life measures. 7) Missing data and missing and inconsistent definitions were common. 8) Baseline measures were often biased because the same assessment was inappropriately but routinely used for both screening and baseline. We conclude that because of these and other problems, there is much that is needlessly unknown about UPPP. It is the responsibility of the research and professional communities to define training, editorial and review procedures that will raise the methodological and statistical quality of published research.

Humans↗
PubMed1992

Mechanisms of airway obstruction in Robin sequence: implications for treatment.

Though the problems associated with Robin sequence may be numerous, especially if the primary cause of the sequence is a multiple anomaly syndrome, the most acute problems in affected newborns is upper airway obstruction. Until recently it has been tacitly assumed that glossoptosis is always the cause of the airway obstruction. More recent evidence has shown that the sources of airway obstruction are multiple and the cause of apnea heterogeneous. The purpose of this paper is to report the mechanisms of upper airway obstruction in 53 infants with Robin sequence. The use of flexible fiber optic endoscopy to specify treatment is discussed in detail.

Airway Obstruction↗
PubMed1990

Obstructive sleep apnea syndrome: a complex disorder of the upper airway.

The pathophysiologic basis for obstructive sleep apnea syndrome (OSAS) is complex, involving the properties of the pharynx, the muscular forces that support its patency, and the homeostatic control mechanisms of respiration. The anatomic basis for OSAS is the skeletal structure of the head and neck as it is reflected in the soft tissue structures comprising and supporting the upper airway. Study of patients with craniofacial anomalies that result in OSAS, and application of similar study techniques to OSAS patients without apparent craniofacial anomalies, point up similarities and lead to a greater understanding of the anatomic aspects of OSAS.

Adult↗
PubMed1987

Hypernasal speech caused by tonsillar hypertrophy.

Twenty patients with hypernasal speech were studied with both flexible fiber optic nasopharyngoscopy and multi-view videofluoroscopy, as well as behavioral speech assessment. Characteristic diagnostic findings showed the hypernasality to be caused by hypertrophic tonsils with posterior placement of the upper poles of the tonsils into the oropharyngeal and nasopharyngeal airway. In 16 of the 20 cases, there was a complete resolution of hypernasal speech following only tonsillectomy with no other treatments. Three patients required a brief period of speech therapy and one additional patient required both speech therapy and temporary prosthetic treatment (speech bulb reduction).

Adolescent↗
PubMed1985

Predictive value of Müller maneuver in selection of patients for uvulopalatopharyngoplasty.

Uvulopalatopharyngoplasty (UPPP) is an effective treatment for some patients with obstructive sleep apnea syndrome (OSAS). A major difficulty has been to select those patients who will have a good response to UPPP. Fiberoptic nasopharyngoscopy with Müller Maneuver (FNMM) was applied in preoperative evaluation of patients with OSAS to identify those in whom greatest pharyngeal collapse was in the region of the tonsillar fossae and soft palate. Those with pharyngeal changes on FNMM who were considered most likely to respond to surgery underwent UPPP. Comparison of pre and postoperative polysomnography reveals significant (p less than .001) improvement in indices of severity of OSAS The mean apnea index (apneas per hour) was diminished by 72%. Eighty-seven percent of patients had greater than 50% reduction in apnea index. Preoperative selection of OSAS patients by FNMM increases the likelihood of success of UPPP.

Adult↗
PubMed1985

Achondroplasia and obstructive sleep apnea: correction of apnea and abnormal sleep-entrained growth hormone release by tracheostomy.

Severe obstructive sleep apnea in a patient with achondroplasia syndrome was found to result in a definitive deficiency of overnight growth hormone secretion related to absence of slow-wave sleep. Resolution of the apnea by tracheostomy resulted in normalization of growth hormone release and normal growth rates postoperatively. Sleep-related growth hormone deficiency may contribute to the short stature so often seen in a variety of craniofacial syndromes. Furthermore, this short stature may be reversible.

Achondroplasia↗