Search Results (55)

Background/Objectives: Drug-induced sleep endoscopy (DISE) is used in obstructive sleep apnea (OSA) to visualize dynamic upper airway collapse, but sedation protocols vary widely with no consensus on the optimal agent or technique. This narrative review aims to clarify current sedation strategies for DISE in OSA and their clinical implications. Methods: We systematically searched PubMed, Scopus, Web of Science, and Cochrane Library for English-language publications on DISE sedation (2000–2025). Relevant clinical studies, guidelines, and reviews were included. Data were qualitatively synthesized due to heterogeneity among studies. Results: Sedation approaches in DISE varied considerably. Propofol, dexmedetomidine, and midazolam were the primary agents identified. Propofol provided rapid, titratable sedation but increased airway collapsibility at higher doses; dexmedetomidine produced a more natural sleep-like state with minimal respiratory depression; midazolam was less favored due to prolonged effects. Use of target-controlled infusion (TCI) and pharmacokinetic–pharmacodynamic (PK–PD) models improved control of propofol sedation. Co-sedative adjuncts (e.g., opioids) reduced the required sedative dose but added risk of respiratory depression. Careful titration to the lowest effective dose-often guided by bispectral index (BIS) monitoring—was emphasized to achieve adequate sedation without artifactual airway collapse. No universal DISE sedation protocol was identified. Conclusions: Optimal DISE sedation balances adequate depth with patient safety to ensure reliable findings. Using the minimum effective dose, guided by objective monitoring (e.g., BIS), is recommended. There is a need for standardized sedation protocols and further research (e.g., in obese patients) to resolve current controversies and improve DISE’s utility in OSA management. Full article

Objective: This study aimed to measure nasal airway resistance (NAR) in obstructive sleep apnea (OSA) patients with nasal obstruction using active anterior rhinomanometry (AAR) and to evaluate whether NAR can predict the indication to include septoplasty as an additional procedure alongside drug-induced sleep endoscopy (DISE) and inferior turbinoplasty. Methods: We performed a retrospective observational study in OSA patients with nasal obstruction. According to nasal endoscopy and CT findings, patients were planned for either DISE with inferior turbinoplasty alone or DISE with inferior turbinoplasty and septoplasty. All patients underwent preoperative AAR, carried out under baseline and post-decongestion conditions. To test the ability of NAR to predict septoplasty indication, receiver operating characteristic (ROC) curves were generated for baseline and post-decongestion values. Logistic regression combined inspiratory/expiratory and unilateral/total NAR. The Area Under the Curve (AUC) was used to evaluate diagnostic accuracy, and optimal cut-offs were identified using Youden’s index (J). Results: Forty-eight patients were included. Baseline NAR showed low accuracy (median AUC: 0.540 unilateral, 0.562 total) and no valid cut-offs were identified (median J: 0.213 unilateral, 0.233 total). Post-decongestion NAR performed better (median AUC: 0.649 unilateral, 0.738 total). Inspiratory and expiratory unilateral values merged with binary regression improved prediction (AUC 0.677 and 0.709). The highest accuracy was achieved when all rhinomanometric parameters were integrated into one logistic model (AUC = 0.947). Conclusions: Preoperative AAR may help refine nasal surgical planning during DISE in OSAS patients, supporting a personalized approach and potentially reducing the need for staged nasal procedures. Full article

Background: Mandibular advancement device (MAD) therapy is a non-invasive treatment for obstructive sleep apnea (OSA). Although the effect of MAD on OSA outcomes is widely known, its effect on the upper airway collapse degree remains poorly understood. This study aimed to assess the impact of MAD therapy on site-specific airway collapse degree during drug-induced sleep endoscopy (DISE). Methods: One hundred participants were recruited and underwent a baseline polysomnography. Overall, 69 participants with OSA (AHI 5–50 events/h) underwent DISE at baseline and with MAD set to 75% of maximal mandibular protrusion. Collapse degree (none, partial, complete) was evaluated at the palate, oropharynx, tongue base, hypopharynx, and epiglottis without and with MAD. Ordinal logistic regression was used to analyze changes in degree of collapse. Results: MAD therapy reduced collapse degree at the palate (OR = 5.92 [3.28; 10.66], p < 0.001), oropharynx (OR = 2.70 [1.48; 4.92], p = 0.001), tongue base (OR = 1.83 [1.32; 2.53], p < 0.001), and hypopharynx (OR = 2.90 [1.53; 5.48, p = 0.001), with no effect at the epiglottis (OR = 0.65 [0.42; 1.02], p = 0.058). Conclusions: MAD therapy reduces upper airway collapse at most anatomical levels, except at the level of the epiglottis. These findings confirm its therapeutic efficacy while underscoring the importance of identifying patients with residual or worsening collapse who may benefit from combined or alternative treatments. Full article

The fact that the Ising model in higher dimensions than 1D features a phase transition at the critical temperature $T_c$ despite its apparent simplicity is one of the main reasons why it has lost none of its fascination and remains a central benchmark in modeling physical systems. Building on our previous work, where an approximative analytic free-energy expression for finite 2D-Ising lattices was introduced, we investigate different extrapolation strategies for estimating $T_c$ of the infinite system from exactly solvable small lattices. Finite square lattices of linear dimension N with free and periodic boundary conditions were analyzed, exploiting their exactly accessible density of states to compute the heat capacity profiles $C\left(T\right)$. Different approaches were compared, including scaling models for the peak temperature $T_{\max }\left(N\right)$ and an envelope construction across the set of $C\left(T\right)$-profiles. We find that both approaches converge to the same asymptotic value and compare favorably to the established Binder cumulant method. Remarkably, a model for $T_{\max }$ with a single model parameter following an $N/(N+1)$-law provides robust convergence, with a physical analogy motivating this proportionality. Our findings highlight that surprisingly few, but highly accurate, finite-size results are sufficient to obtain a precise extrapolation. Full article

Background: Obstructive Sleep Apnea (OSA) is commonly treated with CPAP, though low patient compliance often limits its long-term use. Surgical alternatives, such as Barbed Pharyngoplasty, have been developed to address retro-velar collapse. A recent technique, Barbed Stayed Bridge Pharyngoplasty (BSBP), aims to preserve oropharyngeal anatomy while enhancing airway stability. This study evaluates the immediate postoperative outcomes and patient discomfort following BSBP for OSA. Material and Method: Thirty patients (mean age 40.7 ± 8.9 years; BMI 25.9 ± 1.7) underwent BSBP at Sapienza University of Rome between January 2022 and January 2024. Inclusion criteria included AHI 15–30, BMI ≤ 35, and specific DISE findings. Postoperative outcomes were evaluated using polysomnographic data (AHI, ODI), the Epworth Sleepiness Scale (ESS), pain scores (VAS), edema grading (Ezzat score), and the PPOPS questionnaire. Follow-ups were performed at 12, 24, and 48 h; 1 month; and 6 months postoperatively. Results: Thirty patients (average age 40.7) with mild to moderate OSA underwent surgery. After six months, there was a significant reduction in AHI (from 23.4 ± 2.1 to 7.2 ± 2.6) and ODI (from 21.0 ± 4.1 to 6.5 ± 2.1), along with a statistically significant improvement in the Epworth Sleepiness Scale. Postoperative pain (VAS) decreased from 3.0 ± 1.5 at 12 h to 0.2 ± 0.5 at one month, and edema (Ezzat score) decreased from 2.0 ± 0.6 at 12 h to 0.0 ± 0.0 at one month, both with significant differences. The PPOPS questionnaire scores remained relatively stable, with mean values of 4.9 ± 2.3 at 12 h, 2.7 ± 1.6 at 24 h, 1.2 ± 1.1 at 48 h, and 0.5 ± 0.7 at one month, showing statistically significant change (p < 0.005). No postoperative bleeding occurred. According to Sher’s criteria, the procedure was consistently effective. Conclusions: BSBP significantly reduces AHI and ODI, demonstrating effective symptom resolution with minimal discomfort and rapid recovery. These results suggest that BSBP may be a viable, less invasive surgical technique for OSA surgeries. Full article

Obstructive sleep apnoea (OSA) is a complex health condition associated with significant health risks and diminished quality of life. Despite continuous positive airway pressure (CPAP) being the gold standard treatment for years, its poor adherence is well documented. With the emergence of drug-induced sleep endoscopy (DISE) and phenotypic approach to OSA, traditional surgical and non-surgical treatment pathways have been improved to allow personalised treatment and minimising suboptimal treatment to patients demonstrating various upper airway obstruction of OSA endotypes. Sedation protocol propofol, midazolam and dexmedetomidine have been suggested. The VOTE classification for documenting DISE findings have been proposed to unify results across studies. DISE plays an invaluable role in offering insights on treatment successes for positive airway pressure (PAP) therapy, mandibular advancement device (MAD) therapy, positional therapy, and surgical interventions including palatal surgeries, tongue base surgeries, upper airway stimulation (UAS) surgery and maxillomandibular advancement (MMA). This review aims at consolidating current evidence on DISE protocols, indications, and treatment implications to improve therapeutic success in OSA management. Full article

(1) Background: The Iowa Oral Performance Instrument (IOPI) is the well-established device for assessing tongue strength. The current study aimed to assess the effectiveness of the HEAL device in patients with obstructive sleep apnea (OSA) exhibiting varying degrees of tongue base obstruction, as determined by drug-induced sleep endoscopy (DISE). All participants had undergone modified uvulopalatopharyngoplasty (UPPP), and tongue strength was measured using the IOPI. (2) Methods: This retrospective observational study utilized DISE to assess patterns of upper airway collapse in patients with OSA who were candidates for surgical intervention. Based on DISE findings, patients were divided into two groups: the M group (no or partial tongue base obstruction) and the S group (severe obstruction). The first tongue strength assessment using the IOPI was conducted one month after modified UPPP, prior to initiating HEAL training. Patients then underwent tongue muscle training with the HEAL device, starting one-month post-surgery. A second IOPI assessment was performed after at least one month of training. (3) Results: Forty-nine OSA patients with varying degrees of tongue base obstruction (assessed via DISE) received modified UPPP and were included in the analysis. The mean age was 38.3 ± 7.4 years, and mean BMI was 27.8 ± 3.9 kg/m². After training with the HEAL, average tongue strength increased by 20.6 ± 11.5 kPa. The M group showed significantly greater improvement than the S group (22.45 ± 11.77 vs. 13.33 ± 6.93 kPa, p = 0.024). Linear regression confirmed this difference remained significant (p = 0.024). (4) Conclusions: In this study, participants who received modified UPPP exhibited improvements in tongue base strength following a minimum of one month of training with the HEAL device. Those with no or mild tongue base obstruction, as determined by DISE prior to surgery, experienced greater improvements in tongue strength compared to those with severe tongue base obstruction. Full article

Background: Obstructive sleep apnoea (OSA) affects 1–4% of children and may cause significant health issues if left untreated. While adenotonsillectomy is the primary intervention, up to 33% of children experience residual OSA. Drug-induced sleep endoscopy (DISE) enables identification of the site of anatomical obstruction, thus facilitating targeted surgical interventions. The approach of the institution at which this research was conducted is to only perform DISE in selected patients including those who fail adenotonsillectomy or when adenotonsillectomy is not expected to be successful. Methods: This retrospective case series reviewed 19 children who underwent DISE and DISE-directed surgeries for OSA at Perth Children’s Hospital between 2018 and 2021. Polysomnography (PSG) parameters pre- and post-surgery were compared. Results: Overall, there were no significant improvements in PSG parameters in the group post-surgery. However, improvements were found with sub-group analyses in younger children, those with severe pre-operative OSA and non-obese children. No significant improvement was observed in children with Trisomy 21. Revision adenoidectomy was the most frequently performed surgery and tongue-base reduction achieved the highest rate of improvement (80%) based on PSG parameters. Conclusions: DISE-directed surgery offers a promising approach for managing residual paediatric OSA. Outcomes may be favourable in younger patients, those with severe OSA, and non-obese patients. Further research with larger cohorts is warranted to refine surgical strategies. Full article

The alloy Pr₂Fe_16.75Ni_0.25 has been examined to investigate its structural properties, critical behavior, and magnetocaloric effects. Rietveld’s refinement of X-ray diffraction patterns has revealed a rhombohedral structure with an $R\overline{3}m$ space group. Pr₂Fe_16.9Ni_0.25 also demonstrates a direct magnetocaloric effect near room temperature, accompanied by a moderate magnetic entropy change ($-\mathrm{\Delta }{S}_M^{\max }$ = 5.5 J kg⁻¹ K⁻¹ at ${\mu }_0\mathrm{\Delta }H=5$ T) and a broad working temperature range. Furthermore, the Relative Cooling Power (RCP) is approximately 89% of the widely recognized gadolinium (Gd) for ${\mu }_0\mathrm{\Delta }H=2$ T. This compound exhibits a commendable magnetocaloric response, on par with or even surpassing that of numerous other intermetallic alloys. Critical behavior was analyzed using thermo-magnetic measurements, employing methods such as the modified Arrott plot, critical isotherm analysis, and Kouvel-Fisher techniques. The obtained critical exponents ($\beta$, $\gamma$, and $\delta$) exhibit similarities to those of the 3D-Ising model, characterized explicitly by intermediate range interactions. Full article

Background: Uvulopalatopharyngoplasty (UPPP) and expansion sphincter pharyngoplasty (ESP) are two standard surgical procedures for the treatment of snoring and obstructive sleep apnea. In a retrospective clinical trial, we compared the two surgical techniques regarding objective sleep parameters and patients’ reported outcomes. Materials and Methods: Patients treated with UPPP or ESP between January 2016 and February 2020 were included in this retrospective clinical trial. Pre- and postoperative AHI, BMI, and smoking habits were recorded. Subjective improvement was assessed by the ESS score and symptom relief reported by patients and their bed partners. Results: Between 2016 and 2020, 114 patients were included in the study, 74 patients suffered from OSA, and 30 patients had non-apnoeic snoring (AHI < 5/h). No preoperative sleeping studies were available in 10 patients (10/114; 9%). Based on the findings during drug-induced sedation endoscopy, most patients received an ESP (71/114, 62%), and 43 patients received a UPPP (43/114, 38%). Additionally, in 52/114 (46%), radio frequency ablation of the tongue base was performed if DISE revealed retrolingual collapse. ESP reduced AHI from 21.1 ± 10.8/h to 13.3 ± 12.1/h (p = 0.04), whereas UPPP caused a non-significant decrease in the AHI from 25.0 ± 13.8/h to 18.2 ± 14.6/h (p = 0.6). A minor secondary bleeding was observed in 32 patients, which was effectively treated with electrocautery or conservative therapy (32/114). This was more common in the ESP group (22/71; 31%) than in the UPPP group (10/43; 23%). Postoperative need for analgesics was higher in the ESP group than in the UPPP group. The ESS score showed no significant improvement after UPPP or ESP (p = 0.3), but subjective improvement in snoring was reported by 87/114 (76%) patients. Conclusion: AHI reduction was significantly higher in the ESP patient group than in the UPPP group. ESP patients had a slightly higher rate of minor secondary bleeding and postoperative need for analgesics than UPPP patients. Full article

Science teachers continue to face decreased motivation, lower achievement levels, and decreased enrollment in post-secondary science programs. Teachers ask themselves this question: How do I motivate my students to achieve? Student-centered pedagogies, such as an in-depth pedagogy informed by Self-Determination Theory, can improve students’ motivation by addressing students’ basic psychological needs for autonomy, competency, and relatedness. Problem-based learning presents students with relevant situations and actively engages them in developing plausible solutions to problems. Environmental sustainability encompasses issues concerning our ecological and social environments. Teachers can focus on these issues to develop authentic problem-based learning units that offer a student-relevant pathway to improve motivation and scientific literacy. We propose a pedagogical framework, drawing on Self-Determination Theory, to promote students’ motivation to engage keenly with environmental sustainability education through problem-based learning. This framework is designed for secondary science classrooms to inform science teachers’ pedagogical practice. Full article

Background: Snoring is a common symptom within the spectrum of sleep-disordered breathing, often occurring independently or in association with obstructive sleep apnea syndrome (OSAS). Despite its prevalence, treatment strategies remain variable and lack standardization, particularly regarding surgical interventions. This review aims to evaluate and summarize the outcomes of soft palate and pharyngeal surgeries for adult snoring based on recent literature. Methods: A systematic review was conducted using the PubMed database, identifying studies published between 2014 and 2024 that involved adult patients undergoing upper airway surgery for snoring. Inclusion criteria required pre- and postoperative snoring assessment using the Visual Analog Scale (VAS). Studies were categorized by surgical technique (anterior vs. lateral/circumferential), anesthesia type, presence of tonsillectomy, BMI, OSAS severity (based on AHI), and use of Drug-Induced Sleep Endoscopy (DISE). Descriptive analysis was performed on the changes in VAS scores. Results: A total of 43 studies involving 2713 patients were included, with 18 eligible for quantitative analysis (716 patients). Across all patients, mean VAS scores improved from 7.29 to 3.50 (ΔVAS 3.79). Both anterior and lateral/circumferential techniques yielded significant symptom reduction (ΔVAS 4.12 and 3.68, respectively). General anesthesia showed slightly better outcomes than local anesthesia. Notably, tonsillectomy was associated with greater symptom improvement (ΔVAS 5.17 vs. 4.49). Patients with lower BMI and milder OSAS showed higher baseline VAS but similar improvements. Limited objective measures and heterogeneity in surgical protocols were key limitations. Conclusions: Surgical interventions for snoring provide subjective symptom relief regardless of surgical approach or OSAS severity. Tonsillectomy may enhance outcomes. Future efforts should prioritize standardized, objective outcome measures and personalized treatment planning, potentially incorporating DISE and wearable acoustic technologies. Full article

Background: Optimizing sedative techniques for drug-induced sleep endoscopy (DISE) enhances accuracy and reproducibility in tailoring treatment for obstructive sleep apnea (OSA). The Schnider and Eleveld pharmacokinetic–pharmacodynamic (PK-PD) models, which predict propofol concentration in effect-site compartment based on patient-specific parameters, were utilized to guide intravenous sedation in this study. We compared the effectiveness of propofol sedation guided by the novel general-purpose Eleveld model versus the Schnider model using target-controlled infusion (TCI) systems. Methods: We investigated twenty-five adult OSA patients, randomized into two groups: the Schnider model group (n = 12) and the Eleveld model group (n = 13). DISE was conducted following standardized protocols, targeting effect-site concentration TCI mode. Data concerning sedation levels, effect-site concentration of propofol, procedural timing, propofol dosages, respiratory and cardiovascular parameters, and any procedural incidents were collected. Results: DISE was performed successfully in all enrolled patients from both groups. A significant difference was observed in the effect-site concentration of propofol (CeP) at the moment of endoscopy between the Eleveld and Schnider groups (2.1 ± 0.4 µg/mL vs. 3.3 ± 0.7 µg/mL, respectively; p < 0.001). The E group also demonstrated a shorter time to attain the optimal sedation plane compared to the S group (6.1 ± 1.7 vs. 9.8 ± 2.2 min, respectively; p < 0.001) and a reduced total procedural time (11.2 ± 1.4 vs. 15.0 ± 2.1 min, respectively; p < 0.001). The incidence of adverse events was comparable between groups. Conclusions: The Eleveld model demonstrated a shorter time to achieve the optimal sedation plane, a shorter total procedural time, and a significant difference in effect-site concentration at the time of endoscopy compared to the Schnider model. The incidence of adverse events was comparable between the two groups, suggesting that the Eleveld model may offer improved efficiency without compromising safety during DISE. Full article

Tonsillectomy is considered the standard of care in patients with obstructive sleep apnea (OSA) and large tonsils; however, there are selected cases where this procedure should not be considered. We present two patients with tonsil grade 4 and severe OSA where tonsillectomy was not the solution for their problem and could be a superfluous procedure. In our experience, a preoperatory drug-induced sleep endoscopy (DISE) and proper patient phenotyping will prevent this type of surgical failure. Full article

Background: Mandibular advancement devices (MADs) are considered a primary alternative treatment for adults with moderate to severe obstructive sleep apnea (OSA) who are unable to tolerate or do not respond to continuous positive airway pressure (CPAP) therapy, supported by substantial scientific evidence. While a range of designs and materials for MADs are commercially available, there is a lack of clear diagnostic guidelines to assist clinicians in selecting the most appropriate device based on a multidisciplinary evaluation of OSA patients. This narrative review seeks to outline the key characteristics of MADs that clinicians should evaluate during both the diagnostic and treatment phases for patients with OSA. Methods: An extensive search of academic databases was conducted to gather relevant studies that address therapeutic and diagnostic recommendations for the design and titration of MADs. The search was carried out across EMBASE, Scopus, PubMed, and Web of Science up to May 2024. From a total of 1445 identified citations, 1103 remained after duplicate removal. Based on the inclusion criteria, the full text of 202 articles was retrieved, and 70 studies were ultimately included in this review. The extracted data were organized to generate clinical insights, aimed at guiding orthodontists in optimizing diagnostic and decision-making processes for treating OSA patients with MADs. Results: The analysis led to the identification of key clinical questions that can assist orthodontists in enhancing their approach and choosing the appropriate appliance basing on the diagnosis and clinical dento-orofacial characteristics. Conclusions: Bibloc appliances could be preferred over mono-bloc devices due to the possibility of arranging the mandibular advancement according to the patient’s clinical condition and orofacial symptoms. Provisional devices could be used as screening tools to verify the patient’s adherence to the therapy. Regardless of the MAD design, type and programmed advancement, it must be under-lined that the rule of the orthodontist/dental specialist is secondary to the other sleep-medicine specialists (ORL, pulmonologist) and must be related to (1) a preliminary assessment of MAD usage (dental anatomical conditions), (2) testing a diagnostic MAD usable during a sleep examination (PSG or DISE), (3) final treatment with a definitive MAD. Full article