Biomedical subjects

R Troell

Publications and source records attributed to R Troell.

7 recordsLinked to original sources

PubMed2001

The road to danger: the comparative risks of driving while sleepy.

OBJECTIVES/HYPOTHESIS: A large sector of the population of the United States has sleep deprivation directly leading to excessive daytime sleepiness. The prevalence of excessive daytime sleepiness in this population ranges from 0.3% to 13.3%. The consequences of even 1 to 2 hours of sleep loss nightly may result in decrements in daytime functions resulting in human error, accidents, and catastrophic events. The magnitude of risks in the workplace or on the highways resulting from sleepiness is not fully understood or appreciated by the general population. Hence, to more clearly emphasize the magnitude of these risks, we question whether mild sleep deprivation may have the same effect as alcohol on reaction times and driving performance. STUDY DESIGN: Nonrandomized prospective cohort investigation. METHODS: Sixteen healthy matched adult subjects (50% women) were stratified into two groups, sleep deprived and alcohol challenged. The sleep-deprived group was further subdivided into acute (one night without sleep) and chronic (2 h less sleep nightly for 7 d) sleep deprivation. Each group underwent baseline reaction time testing and then drove on a closed course set up to test performance. Seven days later, the group repeated this sequence after either sleep deprivation or alcohol intake. RESULTS: There were no significant between-group differences (sleep deprivation or alcohol challenged) in the changes before and after intervention for all 11 reaction time test metrics. Moreover, with few exceptions, the magnitude of change was nearly identical in the two groups, despite a mean blood alcohol concentration of 0.089 g/dL in the alcohol-challenged group. On-track driving performances were similar (P =.724) when change scores (hits and errors) between groups were compared (baseline minus final driving trial). CONCLUSION: This comparative model suggests that the potential risks of driving while sleepy are at least as dangerous as the risks of driving illegally under the influence of alcohol.

Adult↗

PubMed2001

Radiofrequency treatment of turbinate hypertrophy in subjects using continuous positive airway pressure: a randomized, double-blind, placebo-controlled clinical pilot trial.

OBJECTIVES: To estimate the treatment effect of temperature-controlled radiofrequency (TCRF) reduction of turbinate hypertrophy in patients with sleep-disordered breathing (SDB) treated with nasal continuous positive airway pressure (CPAP), and to assess the impact of study design on this estimate. STUDY DESIGN: Prospective, randomized, double-blind, placebo-controlled clinical pilot trial. METHODS: Twenty-two CPAP-treated patients with SDB with turbinate hypertrophy were randomly assigned to either TCRF turbinate treatment (mean energy 415 +/- 37 J/turbinate; n = 17) or placebo control (n = 5). Changes in nasal obstruction were evaluated between pretreatment and 4 weeks post-treatment. The primary outcome assessed changes in the blinded examiners' findings of nasal obstruction on a visual analogue scale (VAS). Secondary outcomes included blinded patients' and unblinded examiner assessments of nasal obstruction (VAS), nightly CPAP use, adherence, and tolerance, along with sleepiness and general health status scales. The treatment group findings were subtracted from the changes in the placebo group to yield treatment effect. RESULTS: The primary outcome treatment effect by VAS was -0.9 cm (95% confidence interval [CI], -2.4, 0.7), and beyond the placebo effect of -1.5 cm (95% CI: -3.4, 0.3). The secondary treatment effect of the unblinded examiner was -3.0 cm (95% CI, -4.9, -1.1). A beneficial treatment effect was also seen on every secondary outcome except general health status, but only self-reported CPAP adherence (P = .03) was statistically significant. CONCLUSIONS: TCRF turbinate treatment appears to benefit nasal obstruction and CPAP treatment for SDB. Placebo control and double blinding are critical for establishing the true treatment effect. A future definitive trial is feasible to establish statistical significance of these findings.

Adult↗

PubMed2000

Postoperative airway findings after maxillomandibular advancement for obstructive sleep apnea syndrome.

OBJECTIVE: To evaluate the upper airway characteristics in the early postoperative period after maxilomandibular advancement for obstructive sleep apnea syndrome. METHODS: Nasopharyngolaryngoscopy was performed before and 48 hours after surgery on 70 consecutive patients who underwent maxillomandibular advancement for obstructive sleep apnea syndrome. The preoperative and the postoperative evaluations were performed by the same examiner for consistency. RESULTS: Mild to moderate lateral pharyngeal wall edema was identified in 70 consecutive patients. Fourteen patients (20%) had edema as well as ecchymosis involving the pyriform sinus and aryepiglottic fold. Four of these patients (6%) were also noted to have hypopharyngeal hematoma involving the pyriform sinus, aryepiglottic fold, arytenoid, and false vocal cord that partially obstructed the airway. These four patients were closely monitored for 1 to 2 additional days for possible expanding hematoma leading to airway compromise. None of these patients were found to have airway difficulty, and the minimum oxygen saturation was more than 90% throughout the hospitalization. All four patients were discharged uneventfully, and the hematoma resolved completely within 10 days. CONCLUSION: Although postoperative edema was expected after maxillomandibular advancement, hypopharyngeal hematoma was unexpected. Although none of our patients had evidence of airway difficulty, the possibility of an expanding hypopharyngeal hematoma should be considered in patients complaining of breathing difficulty after maxillomandibular advancement surgery.

Adult↗

PubMed1999

Overview of phase I surgery for obstructive sleep apnea syndrome.

It is well established that obstructive sleep apnea syndrome is associated with increased morbidity and mortality. Surgical therapy has been demonstrated to be a viable treatment option for cure. Thorough presurgical evaluation with the identification of the type of airway abnormality is mandatory to allow for the utilization of a surgical protocol that results in improved clinical outcomes. Phase I surgical protocol is designed to apply specific surgical procedures to alleviate the obstruction(s) present. Following a logical, stepwise surgical approach in airway reconstruction will minimize surgical interventions and avoid unnecessary operations. The incorporation of a risk-management protocol will minimize treatment complications while achieving cure.

Female↗

PubMed1999

Overview of phase II surgery for obstructive sleep apnea syndrome.

Maxillomandibular advancement is an extremely effective surgical procedure for the treatment of obstructive sleep apnea syndrome. When properly executed, it is associated with minimal morbidity and is well accepted by patients. It is a treatment option that achieves long-term care.

Aged↗

PubMed1996

A reversible uvulopalatal flap for snoring and sleep apnea syndrome.

Velopharyngeal incompetence (VPI) is a recognized complication of uvulopalatopharyngoplasty (UPPP) for obstructive sleep apnea. A new uvulopalatal flap (UPF) technique that modifies the UPPP and reduces this risk is presented. The technique achieves the same anatomic results as the UPPP but is reversible. To evaluate clinical outcomes of this new procedure, selected variables were compared in patients who underwent UPPP and UPF procedures. Eighty patients were examined (59/80 UPF, 21/80 UPPP) in a prospective and consecutive manner. Subjects underwent polysomnography and extensive airway evaluations. The characteristics of all patients, at baseline, were evaluated. The study variables included age, sex, body mass index (BMI), palatal length (PNS P) in millimeters, respiratory disturbance index (RDI), lowest oxygen saturation during sleep and a subjective snoring scale. Sixty-seven of the 80 patients underwent simultaneous hypopharyngeal surgery. Data were analyzed with a SAS program. No statistical difference existed between groups. The postoperative character of the palate and the change in snoring scores were the same in all patients (p = 0.584). A positive correlation existed between improvement in the snoring score and the amount of tissue removed or repositioned in the patients treated with UPF (correlation coefficient = 0.370, p = 0.004). In contrast, there was a negative correlation in the UPPP group for the same parameters (correlation coefficient = -0.195, P = 0.409). This suggests there was a difference between these two groups despite the fact that the baseline and postoperative lengths, as well as tissue removed or repositioned, were equivalent. This further suggests that the UPF may reduce snoring to a greater extent than the UPPP. No significant complications were seen in either group. There was no evidence of VPI, even in the early postoperative period. The new reported procedure is reversible and conservative and reduces the risk of VPI. Snoring is improved, which is consistent with a decrease in airway resistance or obstruction.

Adult↗

PubMed1995

Obstructive sleep apnea. Trends in therapy.

The National Commission on Sleep Disorders Research, in its report to Congress, concluded that the primary care community generally does not understand sleep disorders. Obstructive sleep apnea carries a risk of substantial morbidity and mortality. Excessive daytime sleepiness results from fragmented sleep and microarousals associated with apneic events. It causes poor work performance and increases the incidence of automobile accidents due to driving while drowsy. The commission estimates that the loss of productivity in the United States from excessive daytime sleepiness is more than $20 billion per year. Obstructive sleep apnea is strongly associated with hypertension, myocardial infarction, and stroke. Risk factors for obstructive sleep apnea include male sex, obesity, older age, craniofacial anomalies, and familial risk. Treatment is based on documenting the disorder by polysomnography. Medical management of the syndrome includes weight loss and nasal continuous positive airway pressure. A network of follow-up and support is necessary to maintain compliance. Surgical treatment is reserved for those for whom nasal airway pressure treatment fails. A surgical protocol is presented that demonstrates efficacy equal to nasal airway pressure treatment. Primary care physicians should assume the responsibility of identifying patients at risk for obstructive sleep apnea and refer them appropriately.

Humans↗