Drug therapy for OSA?

Generally drug therapy for OSA has had little evidence or pathophysiological leads for successful interventions. This study, albeit using the weight loss route with AHI end points, has shown good effect and warrants attention as far as treatment for overweight OSA goes.
http://www.ncbi.nlm.nih.gov/pubmed/23115402

Premies have more OSA

Who would've guessed someone would do such a study much less the fascinating results? It makes you think why Premies would be more at risk of OSA later on in childhood when they've caught up with their term counterparts. Does being prem predispose to adenoids? Is it retarded lower face craniofacial growth? Or some kind of local oropharyngeal neuropathy?
http://www.ncbi.nlm.nih.gov/pubmed/23115396

Portable monitoring for truckers - good or bad?

It's interesting that this article cites loss of data and loss to follow up as problems with portable monitoring vs full PSGs. My own instinct about this is to go with PM as a screening tool to increase detection and safety for public. But let's see how this debate plays out..

http://www.ncbi.nlm.nih.gov/pubmed/23115397

Continuous Positive Airway Pressure The - PubMed Mobile

More encouraging data on the wavefront of studies on the CVS effects of CPAP therapy on OSA.

Demonstrating an increase in nitric oxide and blood flow and a concommitant decrease in inflammatory mediators, the benefits are similar to and complents pharmacotherapy and exercise for the occlusive and thrombotic vascular diseases - ie. IHD, stroke, PVD.

It will be good to see sleep testing and CPAP become mainstay in the management and prevention of these vascular diseases

http://www.ncbi.nlm.nih.gov/m/pubmed/22278815/

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Polysomnographic findings and clinical presentation of adult men with OSA in China - PubMed

What's useful about this simple descriptive study is that it represents a closer-to-home Asian profile, and a stratification into 3 equal groups of young/middle-aged/elderly men for comparison.

What the demonstrates is that OSA decreases in severity and CSA increases with age!

The questions this raises is:
1- What physiologic mechanisms are at work to reduce upper airway obstruction and inhibit respiratory drive?
2- What does this mean for long-term follow up? Should we retest and how often to see this reduction, potentially reversal of OSA?
3- How does this change management strategies? Is there a role for weaning off CPAP (given the poor compliance rates, long term) and exploring surgical modalities as age advances? (I can see how this is important so that patients, given something to look forward to are not lost on follow up).

http://www.ncbi.nlm.nih.gov/m/pubmed/22276350/

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Children's Asthma Not Eased by Anti-Reflux Drug

This is one good example of how children aren't just small adults and extrapolating our experience treating 'acid asthma' successfully in adults isn't transferrable.

The findings in this study isn't surprising since we do know that asthma is an atopic disease which peaks in early childhood and abates after puberty, while the adult variety is a residual of that or a different entity altogether.

The premise for the success of PPIs in adults I believe is that reflux is responsible for prolonging asthma beyond childhood and also for new onset bronchospasm mimicking asthma.

http://m.voanews.com/english/Childrens-Asthma-Not-Eased-by-Anti-Reflux-Drug-138085933.html
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High rate of neck cancer

The Star highlighted the importance of head & neck cancers in Malaysia, though that paragraph about isn't very clear, it is to say that...
1) NPC is the 5th most common cancer in Malaysia
2) NPC is the top head & neck cancer in Malaysia, and
3) As a group, head & neck cancer is the second most common, after female breast cancer, in Malaysia.

http://thestar.com.my/news/story.asp?file=/2012/1/20/nation/10300494&sec=nation

CPAP cures metabolic syndrome in obstructive sleep apnea (RCT, NEJM)

This is a fascinating study not just because it demonstrates the benefit of CPAP in reducing sugar, blood pressure, cholesterol, and LDL, but more so for its use of a 'sham CPAP' for placebo!

As the commentator notes, it's unclear if the benefits were the direct result of reducing hypoxic events or more indirectly because of increased activity and exercise in the less somnolent. It would be good to control for that.

http://pulmccm.org/main/2012/randomized-controlled-trials/cpap-cures-metabolic-syndrome-in-obstructive-sleep-apnea-rct-nejm/

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Liow: Heavy snorers may have sleep disorder

Our Minister of Health has taken cognizance of the serious health implications of OSA.

http://thestar.com.my/news/story.asp?file=/2012/1/8/nation/10225247&sec=nation

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Chemoradiotherapy for Early-stage Nasopharyngeal Disease - The ASCO Post

Given the better outcomes of Stage III and IV NPC on CCRT, one wonders if the same radiosensitising effect would benefit the earlier stages.

Stage I and IIa NPC has up to now never been candidates for concurrent chemotherapy, since outcomes have been good on radiotherapy alone.

This trial addresses that particular gap in our knowledge and the results suggest that the benefit is not only significant, it is a worthwhile endeavor given the minimal and controllable adverse effects.

http://www.ascopost.com/articles/january-15-2012/chemoradiotherapy-for-early-stage-nasopharyngeal-disease/

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OSA in Pediatric CNS tumor survivors

An interesting study showing a high prevalence of OSA in children CNS tumor survivors. Rather remarkable is that while SDB is highly prevalent, it is the Obstructive apneas that are more prevalent than Central (14 out of 18). Another subgroup of patients to be on the alert for OSA in.

Excessive daytime sleepiness and sleep-... [Pediatr Blood Cancer. 2011] - PubMed - NCBI:

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Oropharyngeal examination to predict sleep apnea severity

It's good to see a study that validates what is widely held belief among ENT surgeons. While assessing the oropharyngeal airway ALONE is hardly a holistic approach, a finding of a narrowed passage by Friedman Tongue Position in a patient with excessive daytime sleepiness or other comorbids of OSA (eg. refractory hypertension, ischemic heart disease) has been highly predictive of OSA in my own practice.


Oropharyngeal examination to... [Arch Otolaryngol Head Neck Surg. 2011] - PubMed - NCBI:

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Coronary CT Angiography Reveals Vessel Involvement in Obstructive Sleep Apnea : Internal Medicine News

An important step forward in delineating the relationship between OSA and IHD.

Already we know, hypoxia and sympathetic stimulation places the heart in a state of myocardial with reduced oxygenation.

The added insult of oxidative injury is the third and lethal blow it seems..

http://www.internalmedicinenews.com/news/cardiovascular-disease/single-article/coronary-ct-angiography-reveals-vessel-involvement-in-obstructive-sleep-apnea/233e32a8fd.html

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Experiments test if implant can block sleep apnea - Leesville, LA - Leesville Daily Leader

An impanted synchronised nerve stimulator to increase muscle tone of the tongue, hence preventing retroglossal obstruction. How ingenious!

http://www.leesvilledailyleader.com/news/x224240986/Experiments-test-if-implant-can-block-sleep-apnea

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Prince Of Wales Hospital In Hong Kong First In Asia To Offer Cancer Patients Image-Guided RapidArc® Radiotherapy

Similar to the high-speed 640 slice CTs, using Arc technology is the most logical thing to do. It really is quite amazing to watch these machines at work.

http://www.medicalnewstoday.com/articles/211522.php

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Guangdong Humen People Suspected Cancer Due To Fumes Emitted From Power Plants - Refractory Industry

The nasopharynx being the airway brusher, fumes and pesticide-bearing wood dusts are always suspect causative agents.

The Humen people are among the most susceptible in the world to NPC and it doesn't help to be fogged in power plant fumes...

http://business.ezinemark.com/guangdong-humen-people-suspected-cancer-due-to-fumes-emitted-from-power-plants-refractory-industry-31c8dac7a09.html

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Antioxidants for deafness

Oxygen free radicals is now the scapegoat for everything from diabetes to cancer; so why not deafness?

We've always relegated presbycusis to just another one of the many unavoidable stigma of ageing, inexplicable and irreversible. Ageing is the next frontier of medicine and free radicals are the sands of time in the storm of decay.

Sci Am reviews a fascinating recent animal study that demonstrated slowing of age-related deafness in rats by the administration of antioxidants. An elegant way of elucidating the mechanism of disease AND its treatment in a single experiment.

Unfortunately, the pharma industry will only seize this to sell us a plethora of antioxidants rather than have us relook at our toxic modern diets and lifestyles!

www.scientificamerican.com/article.cfm?id=preventing-hearing-loss

Things aren't always what they seem at first

Now that 4D IMRT is all the buzz, we are seeing more and more studies on the volume changes of tumors througout the course of chemoradiation. This is imaging science at its best, monitoring progress and titrating treatment according to burden of disease. Perhaps we can learn something in managing other pathologies; like infection for example.

Weekly volume and dosimetric changes during chemoradiotherapy with intensity-modulated radiation therapy for head and neck cancer: a prospective observational study. (http://www.ncbi.nlm.nih.gov/pubmed/20338474)
Bhide SA, Davies M, Burke K, McNair HA, Hansen V, Barbachano Y, El-Hariry IA, Newbold K, Harrington KJ, Nutting CM.
Int J Radiat Oncol Biol Phys. 2010 Apr;76(5):1360-8.

The Master speaks

When it comes to surgical management of NPC, William Wei always has the last word.

So, it's good that he issues refreshers like this one to keep our management strategies abreast with latest developments.

This appears as the article 'Current management strategy of nasopharyngeal carcinoma' in Clin Exp Otorhinolaryngol. 2010 Mar;3(1):1-12
(http://www.ncbi.nlm.nih.gov/pubmed/20379395)

Other review articles of relevance are linked as well.
(http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed&uid=20379395)

New in OSA

This is music to my ears.

Authors Xu H, Huang W, Yu L, and Chen L. published in Acta Otolaryngolica this week an article entitled 'Sound spectral analysis of snoring sound and site of obstruction in obstructive sleep apnea syndrome.'
(http://www.ncbi.nlm.nih.gov/pubmed/20377505)

They showed objectively what we have known intuitively, that the higher the obstruction the lower the pitch of noise generated. In fact they found that lower obstructions had a greater proportion of >800Hz and >2000Hz first-snore sounds than higher obstructions.

This confirms the way we clinically differentiate stertor and stridor, and might even spawn a new wave of polysomnogram parameters.