HSC Section 3 - Trauma, Critical Care and Sleep Medicine

C. Palatal surgery for OSA Yaremchuk K. Palatal procedures for obstructive sleep apnea. Otolaryngol Clin North Am . 2016; 49(6):1383-1397. EBM level Review.............................................................................................199-213 Summary : This article reviews in detail palatal procedures used to treat obstructive sleep apnea. Descriptions and drawings depicting uvulopalatopharyngoplasty, uvulopalatal flap, laser-assisted uvulopalatopharyngoplasty, cautery-assisted palatal stiffening, lateral pharyngoplasty, expansion sphincter pharyngoplasty, Z-palatoplasty, radiofrequency volumetric tissue reduction, and pillar implants are presented. D. Oral appliance therapy Serra-Torres S, Bellot-Arcis C, Montiel-Company JM, et al. Effectiveness of mandibular advancement appliances in treating obstructive sleep apnea syndrome: a systematic review. Laryngoscope . 2016; 126(2):507-514. EBM level 2.........................................................................................................214-221 Summary : This article summarizes the use of different mandibular advancement devices as an alternative to positive airway pressure therapy. The authors reviewed 22 primarily prospective studies, revealing a significant reduction in AHI in the 16/18 papers that reviewed AHI, and a significant reduction in Epworth Sleepiness Scale in the 11 studies evaluating ESS. No significant adverse effects were noted in any of the reviewed articles. E. Home sleep testing Kapur VK, Auckley DH, Chowdhuri S, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med . 2017; 13(3):479-504. EBM level 3.............................................................................222-247 Summary : This systematic review and clinical practice guideline establishes recommendations for diagnosis of obstructive sleep apnea in adults. Protocols for ordering in-facility sleep testing versus home sleep testing are described. Specifically, in-facility testing is recommended for patients with significant cardiorespiratory disease, neuromuscular conditions causing respiratory muscle weakness, awake hypoventilation, chronic opioid use, history of stroke, or severe insomnia. Rosen IM, Kirsch DB, Chervin RD, et al. Clinical use of a home sleep apnea test: an American Academy of Sleep Medicine position statement. J Clin Sleep Med . 2017; 13(10):1205-1207. EBM level 5...............................................................................................................................................248-250 Summary : This article is a consensus statement from the American Academy of Sleep Medicine about guidelines for the clinical use of home sleep apnea testing. The Academy recommends that only a physician diagnose sleep apnea, and only a physician who is board-certified in sleep medicine interpret home sleep testing data.