HSC Section 3 - Trauma, Critical Care and Sleep Medicine

2. DVT management Moubayed SP, Eskander A, Mourad MW, Most SP. Systematic review and meta-analysis of venous thromboembolism in otolaryngology-head and neck surgery. Head Neck . 2017; 39(6):1249-1258. EBM level 2...............................................................................................................................163-172 Summary : This systematic review evaluated the data about venous thromboembolism (VTE) in otolaryngology. Twenty-three studies representing 618,264 patients met inclusion criteria. Incidence of VTE was 0.4%, while bleeding complication incidence was 0.9%. The use of chemoprophylaxis was not associated with a decreased risk of VTE. Head and neck cancer cases had a higher incidence of VTE (0.9%) when compared to non-cancer cases (0.1%). Chemoprophylaxis may not be necessary in otolaryngology surgical cases. A. Hypoglossal nerve stimulation Soose RJ, Gillespie MB. Upper airway stimulation: a novel approach to managing obstructive sleep apnea. Laryngoscope . 2016; 126 Suppl 7:S5-S8. EBM level 5....................................................173-176 Summary : This article presents a succinct overview of upper airway stimulation therapy as an option for patients with moderate to severe OSA who are unable to adhere to CPAP therapy. It reviews the genioglossal contribution to upper airway collapse. A description of early scientific and feasibility studies is included, and the authors outline the results of the multicenter prospective Stimulation Therapy for Apnea Reduction (STAR) trial.

III. SLEEP

Heiser C, Thaler E, Boon M, et al. Updates of operative techniques for upper airway stimulation. Laryngoscope . 2016; 126 Suppl 7:S12-S16. EBM level 5............................................................177-181

Summary : This article provides an overview of neuroanatomy related to the hypoglossal nerve and a detailed description of surgical technique and perioperative care.

Woodson BT, Strohl KP, Soose RJ, et al. Upper airway stimulation for obstructive sleep apnea: 5-year outcomes. Otolaryngol Head Neck Surg . 2018; 159(1):194-202. EBM level 2...........................182-190

Summary : This article provides 5-year results from a prospective cohort study of patients treated for obstructive sleep apnea (OSA) with upper airway stimulation. It describes a response rate (defined as AHI < 20 events per hours and > 50% reduction of AHI after surgery) of 63% at 5 years with a 6% rate of serious device-related events in a cohort of 71 patients who completed the entire protocol. These statistically significant improvements in PSG measures were accompanied by statistically significant improvements in patient quality-of-life measures. B. Drug-induced sleep endoscopy Hohenhorst W, Ravesloot MJL, Kezirian EJ, de Vries N. Drug-induced sleep endoscopy in adults with sleep-disordered breathing: technique and the VOTE Classification system. Operative Techniques Otol . 2012; 23:11-18. EBM level 5..........................................................................................................191-198 Summary : This paper provides an overview of drug-induced sleep endoscopy (DISE) techniques and a description of the VOTE classification, which describes common terminology for the description of upper airway collapse to allow for an individualized approach to treatment options. The review focuses on achieving the appropriate level of sedation and the importance of avoiding oversedation. The authors also discuss the need to develop a common language to report DISE findings and therefore focus a significant portion of the paper on discussing the VOTE classification as this universal qualitative assessment.