Table of Content

20 November 2023 Volume 37 Issue 6

  

Editorial

Current status and future perspectives of research on obstructive sleep apnea comorbidities

REN Xiaoyong

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(6):  1-5.  doi:10.6040/j.issn.1673-3770.0.2023.184

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Obstructive sleep apnea(OSA)is the most common sleep-related breathing disorder, with a high prevalence that causes widespread harm in the population. As OSA progresses, it may damage multiple systems, such as the nervous, cardiovascular, and endocrine systems. OSA and these comorbidities influence and promote each other, and eventually lead to serious adverse consequences. Therefore, emphasizing the relationship between OSA and multi-system comorbidities, carrying out multi-disciplinary team diagnosis and treatment, and providing high-quality, precise, and individualized diagnosis and treatment programs are current research hotspots. This article provides a brief description and discussion of the progress and future direction of research on OSA and its common comorbidities, such as neurocognitive impairment, cardiovascular and cerebrovascular disease, endocrine disease, and head and neck carcinoma. This paper aims to improve our understanding of OSA and its comorbidities and provide ideas for multidisciplinary collaborative diagnosis and treatment of OSA.

Special Contribution

Comparison of upper airway anatomical changes during mandibular protrusion and with mandibular advancement device use

LI Yanru, SHI Yunhan, CAO Lili, LIAO Jianhong, KANG Dan, FEI Nanxi, HAN Demin

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(6):  6-14.  doi:10.6040/j.issn.1673-3770.0.2023.172

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Objective This study aimed to investigate the changes in the upper airway structure during mandibular protrusion and the use of an oral appliance(OA)in patients with obstructive sleep apnea-hypopnea syndrome(OSAHS). Additionally, we explored whether the alterations in the pharyngeal cavity caused by mandibular protrusion could predict structural increment with OA use. Methods Upper-airway MRI was performed on 24 adult patients with OSAHS and 20 controls while awake, during mandibular protrusion, and while wearing an OA. The consistency of anatomical changes in different pharyngeal areas during mandibular protrusion and while wearing an OA was assessed. The characteristics of patients with enlarged retropalatal and retroglossal airways when using an OA were analyzed. Results The apnea-hypopnea index(AHI)of the OSAHS group was 41.8(15.9, 53.5)times/h, and the lowest oxygen saturation was(80.2±9.5)%. Both mandibular protrusion and OA use significantly increased the distance between the mandible and the posterior pharyngeal wall in the OSAHS and control groups(t=-6.853, P<0.001; t=-8.641, P<0.001). The increment with mandibular protrusion was more significant than that with OA use(P<0.05). An increased minimum cross-sectional area and volume in the retropalatal area were observed with OA use. Moreover, the increment with mandibular protrusion was more significant than mandibular protrusion(Z=-2.057, Z=-2.543 in the OSAHS group; Z=-0.201, Z=-2.254 in the control group). Compared with OA use, mandibular protrusion caused a greater increment in the epiglottic area in the control group(Z=2.365). Meanwhile, in patients with OSAHS, a greater increment in the epiglottic area and volume of the retroglossal area were observed with OA use(Z=-2.236, Z=-2.171). The following parameters had predictive value for identifying patients who had enlarged retropalatal and retroglossal airways with OA use: changes in the epiglottic cross-sectional area during mandibular protrusion ［OR=5.489(1.691, 17.815)］, changes in the retropalatal airway minimum cross-sectional area during mandibular protrusion ［OR=4.589(1.320, 15.953)］, and the AHI ［OR=0.935(0.898, 0.974)］. Conclusion The changes in the upper airway structure during mandibular protrusion are consistent with those for OA use. However, certain differences in the amplitude of anatomical changes in different regions of the upper airways were noted. The changes in the pharyngeal cavity area during mandibular protrusion may have predictive value for selecting candidates for mandibular advancement device treatment.

Research Progress

Recent advances in research on the association between intestinal flora and obstructive sleep apnea-related cognitive impairment

GUO Ruixiang, WANG Yan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(6):  15-23.  doi:10.6040/j.issn.1673-3770.0.2022.233

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Objective Obstructive sleep apnea(OSA)is the most common type of sleep-disordered breathing. Cognitive impairment is a serious complication of OSA. Over the past few decades, research on OSA-related cognitive impairment has focused on the involvement of intestinal flora imbalance. Although this area of study has become a research hotspot, the nature of the relationship between gut dysbiosis and OSA-related cognitive impairment as well as the mechanisms through which they interact are still not clearly understood. In this paper, discussion of intestinal microflora, metabolic changes, and secondary host pathological changes,both from the aspects of chronic intermittent hypoxia and sleep fragmentation, involving dietary habit and environmental factor and so on, which will provide a framework through which potential mechanisms of interaction between intestinal microflora imbalance and cognitive impairment secondary to OSA and also describe the effect of traditional continuous positive airway pressure treatment on cognitive function and gut microbiota. Systematic investigation and thorough understanding of this relationship between the microbiota and cognition-related gut-brain axis, is essential for not only proper diagnosis but also development of comprehensive treatment plans that can be tailored to individual patients with OSA and subsequent cognitive impairment.

Role of ferroptosis in inflammatory diseases of the respiratory tract: a review of recent advances

SUN Xiwen, LUO Chunyu, LI Zhipeng, ZHANG Weitian

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(6):  24-32.  doi:10.6040/j.issn.1673-3770.0.2022.241

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Ferroptosis is a form of programmed cell death characterized by the accumulation of iron-dependent lipid peroxides. In recent years, more studies have explored the mechanism of ferroptosis, identifying the crucial role of numerous molecules in its regulation. Emerging evidence has identified ferroptosis in various respiratory inflammatory diseases such as asthma, chronic obstructive pulmonary disease, pulmonary fibrosis, pulmonary infections, and even COVID-19, suggesting its crucial role in respiratory inflammatory disorders. Thus, drugs targeting the mechanism of ferroptosis may have significant therapeutic efficacy in respiratory inflammatory diseases. This review focused on the role and molecular mechanism of ferroptosis in respiratory inflammatory diseases, and proposed multi-angle regulation of ferroptosis as a promising potential strategy for their clinical treatment.

Advances in research on the relationship between obstructive sleep apnea and breast cancer

HU Tingting, WANG Yuehua

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(6):  41-45.  doi:10.6040/j.issn.1673-3770.0.2023.342

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Animal studies suggest that intermittent hypoxia due to obstructive sleep apnea(OSA)is a risk factor for breast cancer. Despite biological plausibility, human epidemiological studies have shown inconsistent results. However, a recent meta-analysis of seven large studies with a total of 5 370 466 patients showed that patients with OSA had a 36% increased risk of breast cancer compared to patients without OSA(HR 1.36, 95%CI 1.03-1.80). This article reviews the research on the relationship between OSA and breast cancer, including the possible pathogenesis of OSA-associated breast cancer.

Research progress of deep learning methods in sleep apnea detection

SHI Zhenghao, ZHOU Liang, LI Chengjian, ZHANG Zhijun, ZHANG Yitong, YOU Zhenzhen, LUO Jing, CHEN Jingguo, LIU Haiqin, ZHAO Minghua, HEI Xinhong, REN Xiaoyong

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(6):  46-61.  doi:10.6040/j.issn.1673-3770.0.2023.190

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Sleep apnea syndrome is a common sleep respiratory disorder caused by partial or complete upper airway obstruction, which can lead to hypertension, coronary heart disease, and other cardiovascular diseases. It also seriously impacts sleep quality and physical and mental health. Sleep polysomnography monitoring is commonly used for determining and confirming sleep apnea, but manually analyzing sleep polysomnography is time-consuming, labor-intensive, and error-prone. In recent years, the research on the application of deep learning methods in sleep apnea detection has received increasing attention. To promote the research development of deep learning-based sleep apnea detection technology, this paper systematically composes and summarizes the current mainstream deep learning-based sleep apnea detection methods, introduces the common sleep apnea detection public datasets, describes the evolutionary development process of deep learning-based sleep apnea detection methods, reviews the deep learning methods in sleep apnea detection in recent years, analyzes the ideas and characteristics of typical methods, characterizes the experimental comparison of typical methods, appraises the problems existing at the present stage of research, and discusses future research and development trends.

Advances in the changes of lymphocytes in pediatric adenoid and tonsil hypertrophy

ZHU Yaxin,LIU Feng,GUAN Jian,YIN Shankai

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(6):  62-67.  doi:10.6040/j.issn.1673-3770.0.2022.096

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Adenotonsillar hypertrophy is the most common cause of pediatric obstructive sleep apnea. The immunopathologic findings of adenotonsillar hypertrophy have become a field of interest due to the lack of a safe and effective medical treatment. Recent local and foreign studies have shown that the excessive inflammatory response and germinal center response in hypertrophied adenotonsillar tissue are related to the abnormal composition and function of the lymphocytes. These characteristics will be described further in this review.

Application value of lipid metabolism markers for the early screening of Alzheimer's disease in obstructive sleep apnea patients

WANG Lu, ZHANG Yunyun, GUO Hua, CUI Xiaochuan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(6):  68-74.  doi:10.6040/j.issn.1673-3770.0.2023.169

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Obstructive sleep apnea(OSA)is a common clinical condition characterized by chronic intermittent hypoxia and sleep fragmentation, which can lead to multi-organ and multi-system dysfunction. Prior research has shown that OSA can increase the risk of Alzheimer's disease(AD), and can also trigger abnormal lipid metabolism, an important pathogenic feature of AD. In this review, we discuss the markers of abnormal lipid metabolism of OSA, discussing the possible involvement of cholesterol, phospholipid, lipoprotein and apolipoprotein metabolism in the onset and progression of Alzheimer's disease. This knowledge will be helpful in the screening of early evaluation indicators of OSA which increase the risk of AD. Further, this knowledge can be used to construct a theoretical basis for the clinical exploration of relevant biomarkers.

Clinical Study

A preliminary study on nocturnal alkali reflux in OSAHS patients

WANG Lei, LI Baowei, WANG Gang, LIU Hongdan, HAN Haolun, ZHANG Xiaoli, WU Wei

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(6):  75-79.  doi:10.6040/j.issn.1673-3770.0.2022.138

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Objective Patients with obstructive sleep apnea and hypopnea syndrome(OSAHS)often have a high incidence of laryngopharyngeal reflux, the purpose of this study was to investigate the characteristics of nocturnal alkali reflux in OSAHS patients. Methods The results of oropharyngeal pH monitoring and simultaneous polysomnography in 98 patients with snoring were analyzed retrospectively. The correlation between abnormally high pH events with pH >7.5 and severity of sleep ventilation disorders was analyzed. Saliva samples were reserved in the morning for trypsin detection by enzyme-linked immunosorbent assays. Results Oropharyngeal pH monitoring results found 33 cases with high pH events(pH >7.5)during nocturnal sleep. The occurrence of high pH events in the OSAHS group was 39.0%(32/82), which was significantly higher than the pure snoring group(6.3%, 1/16)(P=0.011), and similar results were seen with the percentage time of high pH events and the highest pH values(P=0.020, 0.020). Mean salivary trypsin levels were 27.42-401.44 μg/L, of which 17 cases were abnormally increased(275.28±59.13)μg/L. There was no significant difference between the OSAHS and pure snoring groups in trypsin content, but the trypsin content in the 32 OSAHS patients with high pH events differed statistically based on the degree of snoring(P=0.048). Conclusion OSAHS patients were prone to nocturnal high pH events, as revealed through oropharyngeal pH monitoring and abnormally increased saliva trypsin contents in the morning, suggesting that alkaline reflux may occur. However, the mechanisms of alkaline reflux need to be further studied.

The correlation between γ-glutamyl transferase and obstructive sleep apnea syndrome-related hypertension

WANG Teng, YU Lin, LI Sui

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(6):  80-84.  doi:10.6040/j.issn.1673-3770.0.2022.290

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Objective This study aimed to investigate the correlation between serum levels of γ-glutamyl transferase(GGT)and the severity of obstructive sleep apnea syndrome(OSAHS)and hypertension. Methods A total of 312 patients with OSAS who underwent polysomnography were selected as the research subjects. They were divided into four separate groups according to the apnea-hypopnea index(AHI)scores: control group(AHI 0-4), mild OSAS group(AHI 5-15), moderate OSAS group(AHI 16-30), and severe OSAS group(AHI>30). The venous blood GGT was measured within 24 hours after admission, and the differences between groups were compared. The related influencing factors were analyzed by multiple stepwise regression method. The OSAS subjects were further classified into two groups: those with hypertension and those without hypertension. The GGT levels in the groups were compared and statistically analyzed, binary logistic regression was used to analyze the predictive effect of serum GGT level in OSAHS patients with hypertension. Results The serum GGT levels were positively correlated with OSAS severity, and the difference was statistically significant(P<0.001). Multiple stepwise regression analysis showed that serum γ-glutamyl transferase(GGT)was independently correlated with oxygen desaturation index(β=0.557, P<0.001). The level of serum GGT in OSAHS patients with hypertension was significantly higher than that in OSAHS patients without hypertension(P<0.001). The logistic regression analysis showed that elevated serum GGT was an independent predictor of OSAHS with hypertension(OR=1.015, P<0.001). Conclusion The serum GGT levels are positively correlated with the severity of OSAHS and can be used as an independent risk factor to predict the likelihood of developing OSAHS with hypertension.

Clinical significance of peripheral blood inflammatory markers in obstructive sleep apnea hypopnea syndrome with hypertension

YUAN Yuqi, CAO Zine, NIU Xiaoxin, XIE Yushan, SU Yonglong, ZHU Simin, ZHANG Yitong, LIU Haiqin, REN Xiaoyong, SHI Yewen

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(6):  85-92.  doi:10.6040/j.issn.1673-3770.0.2023.174

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Objective To assist with evaluating the patient's condition, we investigated peripheral blood inflammatory marker changes in patients with obstructive sleep apnea hypopnea syndrome(OSAHS)complicated with hypertension. Methods We retrospectively analyzed data from 196 patients with OSAHS diagnosed by polysomnography(PSG). The patients were divided into the simple OSAHS(150 cases)or the OSAHS with hypertension(46 cases)groups. The following inflammatory indexes were calculated: neutrophil-to-lymphocyte ratio(NLR), platelet-to-lymphocyte ratio(PLR), monocyte-to-lymphocyte ratio(MLR), and the systemic immune-inflammation index(SII). The differences of the basic clinical data, PSG parameters, and inflammatory indexes were compared between the two groups. The inflammatory indexes and blood pressure were also correlated. Regression analysis of the variables associated with blood pressure was conducted. Results Considering the inflammatory markers, the NLR, PLR, and SII levels in patients with OSAHS and hypertension were significantly higher than those with only OSAHS(P=0.007; P=0.032; P=0.009). Correlation analysis showed that systolic blood pressure in patients with OSAHS was positively correlated with the body mass index(BMI), apnea-hypopnea index(AHI), NLR, and SII(r=0.195, P=0.006; r=0.195, P=0.006; r=0.208, P=0.004; r=0.246, P=0.001, respectively), and negatively correlated with the lowest oxygen saturation(LSaO₂; r=-0.228, P=0.001). The diastolic blood pressure in patients with OSAHS was also positively correlated with BMI, AHI, NLR, and SII(r=0.160, P=0.025; r=0.210, P=0.003; r=0.145, P=0.043; r=0.206, P=0.004, respectively), and negatively correlated with LSaO₂(r=-0.203, P=0.004). Binary logistic regression analysis showed that age and SII were independent risk factors for the patients with OSAHS and hypertension. Systolic blood pressure and diastolic blood pressure were considered in the multiple linear regression as dependent variables. The results suggest that the longest hypopnea time and SII were risk factors for blood pressure in patients with OSAHS. Conclusion NLR and SII significantly increased in patients with OSAHS and hypertension and were also significantly associated with blood pressure. Thus, clinical monitoring of the above indicators may assist in evaluating the patient's condition.

Clinical characteristics of patients with positional obstructive sleep apnea and their correlations with low arousal threshold

WANG Yuyu, ZHU Mei

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(6):  101-105.  doi:10.6040/j.issn.1673-3770.0.2023.173

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Objective To evaluate the clinical features and arousal threshold of patients with positional and non-positional obstructive sleep apnea. Methods All patients who underwent polysomnography(PSG)were enrolled, their demographic and polysomnographic data were collected, and arousal thresholds were calculated. These data were compared between the positional obstructive sleep apnea(POSA)and non-positional obstructive sleep apnea(NPOSA)groups. Results Among all the 322 patients with OSA, the prevalence of POSA was 48.8%. Patients with POSA had lower BMI, AHI and CT90(26.3 vs. 27.2, P=0.02; 23.2 vs. 56.2, P<0.001; 1.8 vs. 4.9, P=0.044), as well as higher lowest and average oxygen saturation(82.0 vs. 79.0, P=0.038; 95.0 vs. 94.1, P=0.019)compared to patients with NPOSA. Furthermore, a higher percentage of patients with POSA had a low arousal threshold compared to patients with NPOSA(29.3% vs. 8.5%, P<0.001). Conclusion POSA was associated with lower BMI and AHI. Low arousal threshold may play a role in the development of positional OSA.

Metabolic markers in obstruetive sleep apnea hypopnea syndrome patients with different arousal thresholds

XING Liang, YUAN Yuqi, XIE Yushan, SU Yonglong, NIU Xiaoxin, MA Lina, WANG Zitong, LIU Haiqin, SHI Yewen, REN Xiaoyong

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(6):  106-111.  doi:10.6040/j.issn.1673-3770.0.2023.170

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Objective This study aimed to investigate variations in clinical characteristics among patients with obstructive sleep apnea hypopnea syndrome(OSAHS)who exhibit different arousal thresholds and to analyze the correlation between arousal thresholds and clinical factors. Methods We selected 107 adult male patients diagnosed with OSAHS by polysomnography(PSG)from September 2018 to June 2022. The patients were categorized based on their arousal threshold scores and underwent arterial blood gas and biochemical examinations. We compared the PSG parameters, arterial blood gas, dyslipidemia, and fasting plasma glucose. Linear regression was used to estimate the association between significant variables and arousal threshold after adjusting for apnea hypopnea index(AHI). Additionally, we analyzed the correlation between arousal threshold and specific clinical factors. Results The high arousal threshold group had higher AHI, apnea index(AI), longest apnea time(LAT)and mean apnea time(MAT), oxygen desaturation index(ODI), percentage of total sleep time with oxygen saturation below 90%, total cholesterol(TC), and low-density lipoprotein cholesterol(LDL-C)compared to the low arousal threshold group. Conversely, the low arousal threshold group had higher values for the lowest oxygen saturation(LSaO₂)and mean oxygen saturation(MSaO₂)during sleep compared to the high arousal threshold group. However, both TC and LDL-C showed no correlation with arousal threshold after adjusting for AHI. Furthermore, the arousal threshold score was negatively correlated with AHI, AI, LAT and MAT, and positively correlated with LSaO₂ and MSaO₂. Conclusion Patients with OSAHS who had different arousal threshold showed changes in lipid metabolism, which may be potential biomarkers of metabolic disorders in such patients.

Comparative analysis of polysomnography parameters between the first and second halves of the night in snoring patients

ZHANG Yuhuan, ZHANG Junbo, YIN Guoping, YUAN Xuemei, CAO Xin, SUN Yu, CHEN Qiang, YE Jingying

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(6):  112-117.  doi:10.6040/j.issn.1673-3770.0.2023.181

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Objective To compare and analyze the differences in the critical parameters of polysomnography(PSG)between the first and second halves of the night in patients with snoring, including those with obstructive sleep apnea syndrome(OSAS), and to clarify whether the split-night diagnostic results can accurately reflect the patient's overnight status. Methods Patients who presented with sleep snoring and who underwent overnight PSG examination from April to May 2022 were selected as the study population. All of the enrolled patients completed standard overnight PSG examinations. The study period of one night was split into the first and second halves using 2 a.m. as the dividing point, and the relevant PSG parameters of both halves were compared and analyzed. Results Based on the apnea hypopnea index(AHI), a total of 47 patients with OSAS(AHI ≥5 times/h)and 16 patients with simple snoring(AHI <5 times/h)were included. In patients with OSAS, the AHI, oxygen desaturation index(ODI), micro-arousal index(MAI), and proportion of N2 and N3 sleep were significantly higher; whereas, the average blood oxygen level and proportion of rapid eye movement(REM)sleep were significantly lower(P<0.05)during the first half compared with the second half of the night. However, in the 16 patients with simple snoring, only the proportion of N3 sleep was significantly higher and the proportion of REM sleep was significantly lower(all P<0.05)during the first half in comparison with the second half of the night. The difference in AHI(△AHI)before and after midnight in the patients with OSAS ranged from -19.6 to 52.4 times/h, and the median value was 4.9(-2.3, 10.7)times/h. Further analysis showed that △AHI was not significantly correlated with different sleep stages(P>0.05). There were 16 patients(34.0%)with an absolute value of △AHI(|△AHI|)≥10 times/h. Patients with |△AHI| <10 times/h had significantly higher AHI, ODI, and MAI during the first half of the night(P<0.05)than those with |△AHI| ≥10 times/h. Conclusion There was a significant difference in the severity of disease between the first and second halves of the night in the patients with OSAS; this difference was more pronounced during the first half in those with a more severe disease. The results indicated that the PSG data from the first half of the night was not reliable for guiding subsequent treatment. Meanwhile, the aforementioned phenomenon was not obvious in the patients with simple snoring.

The sleep structure of Children with obstructive sleep apnea and the development of a sleep structure interpretation model

ZHANG Yitong, LI Qingxiang, SHI Zhenghao, SHANG Lei, YUAN Yuqi, CAO Zine, MA Lina, LIU Haiqin, REN Xiaoyong, SHI Yewen

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(6):  126-132.  doi:10.6040/j.issn.1673-3770.0.2023.168

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Objective To explore the sleep structure in children with different degrees of obstructive sleep apnea(OSA)and construct an automatic sleep structure interpretation model using deep learning. Methods We retrospectively analyzed the polysomnography(PSG)results of 146 school-aged children, and compared the parameters, such as respiratory events, oxygen saturation, and sleep architecture in children with different severity of OSA. Using deep learning, a hybrid neural network composed of convolutional neural networks(CNN), attention mechanism, and recurrent neural network(RNN)was used to construct an automatic sleep structure interpretation model. A combination of electroencephalogram and electrooculogram were used as input signals. The model’s performance was evaluated using public and private databases. Results There was no significant difference in the percentage of rapid eye movement(REM)and the percentage of non-rapid eye movement(NREM)stage 1 among the primary snoring, mild OSA, and moderate to severe OSA groups(P>0.05). The percentage of the N2 stage was significantly higher in the moderate-severe OSA group than in the primary snoring and the mild OSA groups(P=0.024). The percentage of the N3 stage was significantly lower in the moderate-severe OSA group than in the primary snoring and the mild OSA groups(P<0.001). The total arousal index(ARtotI)and respiratory arousal index(RAI)in the moderate-severe OSA group were significantly lower than those in the primary snoring and the mild OSA groups(P<0.001). Using the public database, the automatic sleep structure interpretation model proposed in this study had an overall accuracy of 79.90%, and F1 values of 45.90%, 85.40%, 83.70%, and 79.90% in N1, N2, N3, and R stages, respectively. Using the private database, the overall accuracy was 71.30%, and the F1 values were 40.20%、81.60%、77.70%, and 67.40% in N1, N2, N3, and R stages, respectively. Conclusion The sleep structure of children with moderate-to-severe OSA showed a prolonged NREM2 and a shortened NREM3. Overall, the deep learning-based automatic sleep structure interpretation model demonstrated stability and a good classification effect.

Study on the clinical observation of Tuina in the treatment of infantile hypertrophy based on apnea hypopnea index

CUI Jiawen, WANG Yichao, LIU Kunpeng, WANG Shuxia, HU Lijun, GU Fei

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(6):  133-138.  doi:10.6040/j.issn.1673-3770.0.2022.230

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Objective This study aimed to investigate the clinical effect of Tuina in the treatment of pediatric adenoid hypertrophy by observing the change in hypoventilation index in children with adenoid hypertrophy before and after treatment. Methods Sixty children with adenoid hypertrophy were randomly included in the treatment and control groups and were treated with Tuina therapy and mometasonefuronate nasal spray(Nasonex), respectively. The changes in the hypoventilation indices in children before and after treatment with Tuina or drug therapy were compared. Results There was a significant difference in hypoventilation indices in intra-group comparisons(P<0.001 for the Tuina group and P<0.001 for the drug group)and in the inter-group comparisons(P<0.001). Conclusion The hypoventilation index of children with adenoid hypertrophy improved significantly after Tuina therapy. Tuina can improve Tuina improves the ventilation of the Eustachian tube in children with adenoid hypertrophy more effectively than drug treatment.

Application study of the MDT module combined with a flipped classroom in clinical teaching of pediatric OSA

ZONG Chunlin, LU Jinbiao, YANG Yong, SU Zhongping, YU Bo

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(6):  139-144.  doi:10.6040/j.issn.1673-3770.0.2023.171

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Objective To explore the application effects of the multidisciplinary treatment(MDT)module combined with flipped classroom teaching methodology on the clinical teaching of obstructive sleep apnea(OSA)in children. Methods Students who entered the School of Stomatology, Fourth Military Medical University, for clinical internships in June 2022 were selected as the research subjects and were randomly divided into the traditional teaching group(n=22, those taught via traditional classroom teaching)and the MDT teaching group(n=23, those taught via the MDT module combined with a flipped classroom teaching method). After the course, the satisfaction of teaching methods was evaluated through a questionnaire survey and the degree of knowledge mastering was evaluated by theoretical examinations. The results were statistically analyzed. Results The results showed that the average score of the MDT group's theoretical exam was significantly higher than that of the traditional group(P<0.05). The survey questionnaire results showed that the MDT group scored significantly higher than the traditional group in terms of classroom interest, classroom interaction, knowledge mastery, autonomous learning ability, teamwork enhancement, and teaching mode preference. However, the scores of learning efficiency and teachers' role embodiment displayed no significant difference between the two groups. Conclusion The combination of the MDT mode and flipped classroom teaching method can improve clinical teaching effects of internship students in terms of pediatric OSA.

A clinical investigation of the hematological parameters related to obstructive sleep apnea in Children

YUAN Chenyang, FENG Chen, WANG Yan, LI Yanzhong, FANG Zhensheng

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(6):  145-152.  doi:10.6040/j.issn.1673-3770.0.2023.226

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Objective This study investigated the differences in hematological parameters between children with and without obstructive sleep apnea(OSA), and the variations in hematological parameters among children with varying severity and clinical phenotypes of OSA. The research aimed to provide a theoretical framework for the diagnosis and precise treatment of pediatric OSA. Methods The study included 76 children diagnosed with OSA due to snoring and 37 children in the control group who visited the Otolaryngology department for consultation. Data, such as medical history, radiological examinations, physical examinations for both groups, sleep breathing monitoring results, and peripheral blood parameters including WBC, HB, ANC, ALC, PLT, MPV, PDW, RDW, NLR, and PLR, were analyzed. Results Children with OSA showed elevated hematological indices(WBC, ANC, ALC, HB, NLR, PLR, PLT, and MPV)compared to children without OSA. In particular, RDW exhibited a significant difference between the two groups(P=0.001). Subgroups of children with different OSA severity were evaluated and the results showed that the WBC, ANC, ALC, NLR, RDW, and PLT levels increased with increasing OSA severity. Moreover, WBC, ANC, and NLR were significantly different between the subgroups(P<0.001; P<0.001; P=0.017). Notably, children with significant adenoid hypertrophy displayed significantly higher WBC, ANC, and NLR levels compared to those with pathological hypertrophy, moderate hypertrophy, and the control group, with ANC and NLR showing statistical significance(P=0.014; P=0.015). Conclusion Peripheral blood inflammatory parameters can serve as essential indicators of OSA in the clinical setting. These parameters can assist clinical physicians in the examination, prediction, and evaluation of pediatric OSA and its severity OSA. Of the analyzed parameters, WBC, ANC, and NLR are readily available clinical indices, and thus, may be considered as potential predictive factors for the pediatric OSA and its severity, in addition to other systemic inflammatory levels.

Observation on the therapeutic effect of oropharyngeal exercise on adult obstructive sleep apnea hypopnea syndrome

DING Longqing, LIU Yiming, CHENG Zhuo, SUN Ran, LIANG Hui

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(6):  153-158.  doi:10.6040/j.issn.1673-3770.0.2023.358

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Objective This study aimed to observe the therapeutic effect of oropharyngeal exercise on adult obstructive sleep apnea hypopnea syndrome(OSAHS). Methods Sixty adult patients who met the diagnosis and inclusion criteria of OSAHS were randomly divided into the experimental and control groups. The experimental group was divided into the genioglossus, soft palate, and non-genioglossus groups and received pharyngeal muscle training with changes in the pharyngeal cavity for 12 weeks. The control group received oropharyngeal exercise training without changing the pharyngeal cavity for 12 weeks. The polysomnography indexes were collected before treatment and 12 weeks after treatment. Statistical software was used to analyze the difference of the curative effect of related indexes. Results There was no significant difference in the age, sex, and body mass index between the experimental and control groups(P=0.201, 0.439, 0.816, 0.326, 0.294). In the comparison of treatment effects, the apnea-hypopnea index(AHI)of each group was lower than that before treatment, and the difference was statistically significant(P=0.005, <0.001, 0.003, 0.001). The lowest oxygen saturation in the four groups was higher than that before treatment, and there was a significant difference between the four groups(P=0.019, 0.020, 0.001, 0.001). There was no significant difference in AHI and lowest oxygen saturation between the experimental and control groups(P=0.776, 0.770). Conclusion The mode of oropharyngeal exercise in the control and experimental groups is helpful in treating patients with OSAHS, and there is no significant difference among the four groups.

Clinical data analysis of 36 cases of antrochoanal polyp in Children

XU Hongming, FAN Wenyan, PU Shilei, LI Xiaoyan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(6):  159-163.  doi:10.6040/j.issn.1673-3770.0.2022.218

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Objective This paper explored the safety and efficacy of sinus absorbable steroid sustained-release implantation system in the treatment of antrochoanal polyp in children. Methods A total of 36 pediatric patients with antrochoanal polyps were divided into study group(26 cases)and control group(10 cases), depending on whether or not a sinus absorbable steroid sustained-release implantation system was implanted into the sinus cavity. All the patients were followed up for half a year. Visual analogue scale and Lund-Kennedy score were used to evaluate the symptoms and mucous membrane of the operative cavity. Results The mean age of the study group was(8.51±2.76)years, and that of the control group was(7.80±2.76)years, with no statistical difference(P=0.525). There was no significant difference in male/female ratio between the two groups(P=0.854). There was no significant difference in the symptom score between the two groups at one and three months of follow-up after the operation(P=0.485; P=0.113, respectively), but the symptom score of the study group was significantly improved compared with the control group at six months after the operation(P<0.05). The Lund-Kennedy score of the study group was significantly better than that of the control group at one month of follow-up(P<0.05), but there was no significant difference at 3, 6, and 12 months of follow-up(P=0.158, P=0.087, and P=0.555, respectively). There was respectively one case of recurrence in the study and control groups(3.85%/10%), with no statistical difference between the two groups(P=0.484). There were no intra-orbital and intra-cranial complications in the study and control groups. Conclusion In the surgical treatment of children with antrochoanal polyps, the application of sinus absorbable steroid sustained-release implantation system can effectively improve postoperative symptoms and operative cavity conditions. However, there was no statistical difference in recurrence rate, which needs to be verified by further clinical studies with a larger sample size. There was no increase in postoperative complications associated with sinus stents in this study.

Analysis of predictive factors of surgical outcomes in patients with nasal septum deviation

YANG Bo, QIU Changyu, ZOU Xinyuan, YIN Min, ZHU Xinjie, CHENG Lei, LU Meiping

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(6):  164-170.  doi:10.6040/j.issn.1673-3770.0.2022.104

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Objective To analyze the preoperative characteristics of patients with nasal septum deviation and the improvement of postoperative symptoms to determine the relevant factors that could predict the surgical outcome. Methods A prospective study was conducted on 53 patients with nasal septal deviation and whose main complaint was nasal congestion. Each patient underwent preoperative history taking, physical examination, auxiliary examination induding nasal endoscopy, paranasal sinus CT, acoustic rhinometry, rhinomanometry, and peak nasal inspiratory flow(PNIF). They also completed an anxiety self-assessment scale(SAS), depression self-assessment scale(SDS), and nasal obstruction visual analogue scale(VAS)at day and night respectively. The improvement of the nasal obstruction symptom evaluation(NOSE)scale score, sino-nasal outcome test 22(SNOT-22)score, and patient's postoperative satisfaction were assessed at one month and six months after surgery. Results The degree of improvement in NOSE scores was correlated with PNIF(r=-0.33), and the degree of improvement in SNOT-22 scores was correlated with SAS scores(r=-0.31). VAS scores for nocturnal nasal congestion were correlated with the degree of improvement in NOSE(r=-0.36)and SNOT-22 scores(r=-0.37). In a multifactorial regression analysis, patient satisfaction with the operation was only associated with the VAS scores for nocturnal nasal congestion(OR=1.65, 95% CI=1.09-2.48, P=0.02). Conclusion The evaluation of patients' preoperative nasal congestion characteristics as well as their psychological status can help clinicians to evaluate patients' prognosis, in order to further select reasonable treatment for patients and optimize the procedure of diagnosis and care for nasal septal deviation.