Advances in the Role of Drug-Induced Sleep Endoscopy in Investigating Sleep Apnea

Abstract

Purpose of Review

Our aim is to highlight the current advances and the role of drug-induced sleep endoscopy (DISE) in investigating sleep apnea.

Recent Findings

Since drug-induced sleep is not necessarily identical to natural sleep, proper level of sedation is important. When using propofol, clinically useful determinations of airway obstruction seem to occur at medium sedation, which is most probably achieved with a blood propofol concentration of 3.2 μg/ml. Historically, recommendations were to perform DISE in the worse sleeping position, which is almost always the supine position. In positional dependent obstructive sleep apnea (POSA), evaluation of the upper airway in lateral position becomes more important and can be mimicked by lateral head rotation alone. Simulation bites and systems as the matrix provide higher accuracy to simulate the possible effect of oral appliance therapy (OAT) compared to manual jaw thrust. When evaluating awake examination versus DISE for surgical decision making, a modification was made in 50% after DISE. Multilevel surgery was performed less after preoperative DISE screening (8 versus 59.5%) and surgical success rate was increased (86 versus 51.4%).

Summary

Drug-induced sleep endoscopy can be used for assessment of the upper airway in patients diagnosed with OSA and is essential to determine site-specific treatment and individual patient management. Management of OSA is slowly moving away from CPAP treatment only, and evidence is rising that assessment with DISE changes surgical and non-surgical treatment planning and increases treatment outcome.

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Mineralization-defects are comparable in fluorotic impacted human teeth and fluorotic mouse incisors

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Rozita Jalali, Franck Guy, Samaneh Ghazanfari, Don Lyaruu, Leo van Ruijven, Pamela DenBesten, Stefania Martignon, Gina Castiblanco, Antonius L.J.J. Bronckers
ObjectiveFluoride excess of 0.05–0.07mgF/kgbw/day in water or food additives like salt is the principal cause of endemic dental fluorosis. How fluoride causes these defects is not clear yet. Recent studies in rodents suggest that development of enamel fluorosis is associated with insufficient neutralization of protons released during the formation of hypermineralized lines.DesignHere we examined whether hypermineralization could also be assessed by MicroCT in developing molar enamel of humans exposed to fluoride.ResultMicro-CT analysis of hypomineralized enamel from human fluorotic molars graded by the Thylstrup–Fejerskov (TF) Index as III–IV showed weak hypermineralized lines and hypermineralized patches not seen in TF-I/II grade enamel. The mesio-distal sides of these molar teeth were significantly smaller (∼18%, p=0.02) than in TF-I/II teeth.ConclusionThe patterns of changes observed in human fluorotic teeth were similar to those in fluorotic rodent incisors. The data are consistent with the hypothesis that also in developing human teeth fluoride-stimulated local acidification of enamel could be a mechanism for developing fluorotic enamel.



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Mineralization-defects are comparable in fluorotic impacted human teeth and fluorotic mouse incisors

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Rozita Jalali, Franck Guy, Samaneh Ghazanfari, Don Lyaruu, Leo van Ruijven, Pamela DenBesten, Stefania Martignon, Gina Castiblanco, Antonius L.J.J. Bronckers
ObjectiveFluoride excess of 0.05–0.07mgF/kgbw/day in water or food additives like salt is the principal cause of endemic dental fluorosis. How fluoride causes these defects is not clear yet. Recent studies in rodents suggest that development of enamel fluorosis is associated with insufficient neutralization of protons released during the formation of hypermineralized lines.DesignHere we examined whether hypermineralization could also be assessed by MicroCT in developing molar enamel of humans exposed to fluoride.ResultMicro-CT analysis of hypomineralized enamel from human fluorotic molars graded by the Thylstrup–Fejerskov (TF) Index as III–IV showed weak hypermineralized lines and hypermineralized patches not seen in TF-I/II grade enamel. The mesio-distal sides of these molar teeth were significantly smaller (∼18%, p=0.02) than in TF-I/II teeth.ConclusionThe patterns of changes observed in human fluorotic teeth were similar to those in fluorotic rodent incisors. The data are consistent with the hypothesis that also in developing human teeth fluoride-stimulated local acidification of enamel could be a mechanism for developing fluorotic enamel.



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In Response.

No abstract available

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In Response: Concerns With Rate of Rise of Carbon Dioxide During Apnea With Buccal Oxygenation.

No abstract available

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The Subtleties of Language as a Reason for Failure to Follow Preoperative Fasting Guidelines: The Differences Between Restricting, Allowing, and Encouraging.

No abstract available

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Core Temperature Monitoring in Obstetric Spinal Anesthesia Using an Ingestible Telemetric Sensor.

BACKGROUND: Perioperative hypothermia may affect maternal and neonatal outcomes after obstetric spinal anesthesia. Core temperature is often poorly monitored during spinal anesthesia, due to the lack of an accurate noninvasive core temperature monitor. The aim of this study was to describe core temperature changes and temperature recovery during spinal anesthesia for elective cesarean delivery. We expected that obstetric spinal anesthesia would be associated with a clinically relevant thermoregulatory insult (core temperature decrease >1.0[degrees]C). METHODS: A descriptive study was conducted in 28 women. An ingestible telemetric temperature sensor was used to record core temperature over time (measured every 10 seconds). The primary outcome was the maximum core temperature decrease after spinal anesthetic injection. The secondary outcomes were lowest absolute core temperature, time to lowest temperature, time to recovery of core temperature, hypothermic exposure (degree-hours below 37.0[degrees]C), and the time-weighted hypothermic exposure (median number of degrees below 37.0[degrees]C per hour). Basic descriptive statistics, median spline smooth, and integration of the area below the 37.0[degrees]C line of the temperature-over-time curve were utilized to analyze the data. RESULTS: Intestinal temperature decreased by a mean (standard deviation) of 1.30[degrees]C (0.31); 99% confidence interval (CI), 1.14 to 1.46 after spinal anesthetic injection. The median (interquartile range [IQR]) time to temperature nadir was 0.96 (0.73-1.32) hours (95% CI, 0.88-1.22). Fourteen of the 28 participants experienced intestinal temperatures below 36.0[degrees]C after spinal injection. Temperature was monitored for a minimum of 8 hours after spinal injection. In 8 of 28 participants, intestinal temperature did not recover to baseline during the monitored period. A median (IQR) of 4.59 (3.38-5.92) hours (95% CI, 3.45-5.90) was required for recovery to baseline intestinal temperature in the remaining 20 patients. Participants experienced a median (IQR) of 1.97 (1.00-2.68) degree-hours of hypothermic exposure (95% CI, 1.23-2.45). The median (IQR) number of degrees below 37.0[degrees]C per hour was 0.45 (0.35-0.60) (95% CI, 0.36-0.58). CONCLUSIONS: During cesarean delivery under spinal anesthesia, women experienced a rapid decrease in core temperature. Using an intestinal telemetric sensor, the perioperative thermal insult and recovery were documented with high resolution. Fifty percent of participants in this study became hypothermic. Although the surgical procedure is typically of short duration, women undergoing spinal anesthesia for cesarean delivery experience significant hypothermic exposure and compromised thermoregulation for several hours. (C) 2017 International Anesthesia Research Society

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