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  • 1
    Online Resource
    Online Resource
    International Consensus Statement on Obstructive Sleep Apnea
    Wiley ; 2023
    In:  International Forum of Allergy & Rhinology Vol. 13, No. 7 ( 2023-07), p. 1061-1482
    Details
    In: International Forum of Allergy & Rhinology, Wiley, Vol. 13, No. 7 ( 2023-07), p. 1061-1482
    Abstract: Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). Methods Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence‐based review (EBR), or evidence‐based review with recommendations (EBR‐R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. Results The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA‐associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. Conclusion This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence‐based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.
    Type of Medium: Online Resource
    ISSN: 2042-6976 , 2042-6984
    URL: Issue
    URL: Article
    DOI: 10.1002/alr.v13.7
    DOI: 10.1002/alr.23079
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2604059-1
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  • 2
    Online Resource
    Online Resource
    Dysphagia in an 8-Year-Old Child
    SAGE Publications ; 2022
    In:  Ear, Nose & Throat Journal
    Details
    In: Ear, Nose & Throat Journal, SAGE Publications
    Type of Medium: Online Resource
    ISSN: 0145-5613 , 1942-7522
    URL: Article
    DOI: 10.1177/01455613221102866
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2067528-8
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  • 3
    Online Resource
    Online Resource
    Tracheostomy in Extremely Preterm Neonates in the United States: A Cross‐Sectional Analysis
    Wiley ; 2020
    In:  The Laryngoscope Vol. 130, No. 8 ( 2020-08), p. 2056-2062
    Details
    In: The Laryngoscope, Wiley, Vol. 130, No. 8 ( 2020-08), p. 2056-2062
    Abstract: Bronchopulmonary dysplasia (BPD) and invasive respiratory support is increasing among extremely preterm neonates. Yet, it is unclear if there is a corresponding increase in tracheostomies. We hypothesize that in extremely preterm neonates with BPD, the incidence of tracheostomy has increased. Study Design Retrospective cross‐sectional analysis. Methods We analyzed the 2006 to 2012 Kids’ Inpatient Databases (KID) for hospital discharges of nonextremely preterm neonates (gestational age 〉 28 weeks and 〈 37 weeks or birth weight 〉 1,500 g) and extremely preterm neonates (gestational age ≤28 weeks or birth weight ≤1,500 g). We studied tracheostomy placement trends in these two populations to see if they are increasing among extremely preterm neonates, especially those with BPD. Results The study included 1,418,681 preterm neonates (52% male, 50% white, 19% black, 20% Hispanic, 4.2% Asian), of whom 118,676 (8.4%) were extremely preterm. A total of 2,029 tracheostomies were performed, of which 803 (0.68%) were in extremely preterm neonates. The estimated percent change of occurrence of extremely preterm neonates with BPD increased 17% between 2006 and 2012, and tracheostomy placement increased 31%. Amongst all who received tracheostomies, mortality rate was higher in extremely preterm neonates compared to nonextremely preterm neonates (18% vs. 14%, P = .05). However, in extremely preterm neonates, those with tracheostomies had a lower mortality rate compared to those without (18% vs. 24%, P = .002). Conclusions Extremely preterm neonates, compared to nonextremely preterm neonates, experienced a marked increase in tracheostomies placed from 2006 to 2012 as well as an increased incidence of BPD, confirming our primary study hypothesis. Level of Evidence 4 Laryngoscope , 130: 2056–2062, 2020
    Type of Medium: Online Resource
    ISSN: 0023-852X , 1531-4995
    URL: Issue
    URL: Article
    DOI: 10.1002/lary.v130.8
    DOI: 10.1002/lary.28304
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2026089-1
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  • 4
    Online Resource
    Online Resource
    Predictors of sleep hypoxemia in children with cystic fibrosis
    Wiley ; 2019
    In:  Pediatric Pulmonology Vol. 54, No. 3 ( 2019-03), p. 273-279
    Details
    In: Pediatric Pulmonology, Wiley, Vol. 54, No. 3 ( 2019-03), p. 273-279
    Abstract: To identify the determinants of nocturnal hypoxemia in children with CF using clinical parameters, polysomnography (PSG), and lung function. Hypothesis Sleep hypoxemia in children with CF is predicted by both apnea hypopnea index (AHI) and percent predicted forced expiratory volume in one second (pFEV1). Design Retrospective case series. Methods Children aged 5‐18 years were included based on (i) a diagnosis of CF; and (ii) availability of concurrent PSG and pFEV1 data. The impact of (i) demographic and clinical parameters; and (ii) PSG and pFEV1, on the total sleep time spent with arterial oxygen saturation below 90% (TSpO 2   〈  90) was measured using regression analysis. P ‐value 〈 0.05 was considered significant. Results The mean age was 11.6 years (95% confidence interval: 9.5, 13.1). Twenty of 35 (57%) were boys and the mean body mass index percentile was 42.1 (31.5, 52.6). The most common ethnicity was white (66%). OSA was diagnosed in 50%. Neither demographic predictors nor clinical variables predicted the severity of hypoxemia ( R 2  = 0.23, P  = 0.09). While pFEV1 and PSG variables accounted for significant proportion of the overall variance in TSpO 2   〈  90 ( R 2  = 0.53, P   〈  0.001), pFEV1 was identified as the single best predictor of sleep hypoxemia. A pFEV1 cut‐off of 53% indicated a sensitivity of 0.80 and a specificity of 0.87 in predicting sleep hypoxemia. Conclusions pFEV1 is the best predictor of sleep hypoxemia in children with CF and referred for PSG. No demographic or clinical predictors of hypoxemia were identified in this population.
    Type of Medium: Online Resource
    ISSN: 8755-6863 , 1099-0496
    URL: Issue
    URL: Article
    DOI: 10.1002/ppul.v54.3
    DOI: 10.1002/ppul.24233
    Language: English
    Publisher: Wiley
    Publication Date: 2019
    detail.hit.zdb_id: 1491904-7
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  • 5
    Online Resource
    Online Resource
    An Incidental Mass on CT in an Otherwise Asymptomatic Patient With Heat Stroke
    SAGE Publications ; 2019
    In:  Ear, Nose & Throat Journal Vol. 98, No. 4 ( 2019-04), p. 203-204
    Details
    In: Ear, Nose & Throat Journal, SAGE Publications, Vol. 98, No. 4 ( 2019-04), p. 203-204
    Type of Medium: Online Resource
    ISSN: 0145-5613 , 1942-7522
    URL: Article
    DOI: 10.1177/0145561318823977
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
    detail.hit.zdb_id: 2067528-8
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  • 6
    Online Resource
    Online Resource
    Chronic Granulomatous Disease of the Upper Airway
    SAGE Publications ; 2021
    In:  Ear, Nose & Throat Journal
    Details
    In: Ear, Nose & Throat Journal, SAGE Publications
    Type of Medium: Online Resource
    ISSN: 0145-5613 , 1942-7522
    URL: Article
    DOI: 10.1177/01455613211054635
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
    detail.hit.zdb_id: 2067528-8
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  • 7
    Online Resource
    Online Resource
    Weight gain velocity as a predictor of severe obstructive sleep apnea among obese adolescents
    Wiley ; 2020
    In:  The Laryngoscope Vol. 130, No. 5 ( 2020-05), p. 1339-1342
    Details
    In: The Laryngoscope, Wiley, Vol. 130, No. 5 ( 2020-05), p. 1339-1342
    Abstract: To evaluate a cohort of obese adolescents with obstructive sleep apnea (OSA) to determine if increased yearly weight gain was a predictor of severe OSA. Study Design Retrospective cohort study. Methods Obese adolescents (body mass index percentile 〉 95% for that age and sex based upon the Centers for Disease Control and Prevention weight classifications), ages 12 to 17 years, referred for full night polysomnography (PSG) were analyzed. We examined demographics, weight classifications, yearly weight gain from age 9 years onward, PSG data (apnea‐hypopnea index), and tonsil size. We performed a mixed‐effect linear regression model to test whether the velocity of weight gain was increased in obese patients with severe OSA when compared to those without severe OSA. Results This study included 166 obese adolescents, 105 with and 61 without severe OSA. The average age was 14 years and was predominately male (57%) and Hispanic (44%). The regression analysis found that the yearly change in weight among obese adolescents with severe OSA was significantly higher than those without (B = 1.4, standard error = 0.50, P = .005, 95% confidence interval: 0.42–2.4). For the group with severe OSA, weight increased 6.5 kg every year before their PSG, whereas for those without, weight increased 5.1 kg per year. Conclusions The rate of weight gain over time is an important predictor of severe OSA in obese adolescents. Level of Evidence 3b Laryngoscope , 130:1339–1342, 2020
    Type of Medium: Online Resource
    ISSN: 0023-852X , 1531-4995
    URL: Issue
    URL: Article
    DOI: 10.1002/lary.v130.5
    DOI: 10.1002/lary.28296
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2026089-1
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  • 8
    Online Resource
    Online Resource
    Racial Influences on Pediatric Tracheostomy Outcomes
    Wiley ; 2022
    In:  The Laryngoscope Vol. 132, No. 5 ( 2022-05), p. 1118-1124
    Details
    In: The Laryngoscope, Wiley, Vol. 132, No. 5 ( 2022-05), p. 1118-1124
    Abstract: To determine the impact of race on outcomes after pediatric tracheostomy. Study Design Retrospective case series. Methods A case series of tracheostomies at an urban, tertiary care children's hospital between 2014 and 2019 was conducted. Children were grouped by race to compare neurocognition, mortality, and decannulation rate. Results A total of 445 children with a median age at tracheostomy of 0.46 (interquartile range [IQR]: 0.97) years were studied. The cohort was 32% Hispanic, 31% White, 30% Black, 2.9% Asian, and 4.3% other race. Black com pared to White children had a lower median birth weight (2,022 vs. 2,449 g, P  = .005), were more often extremely premature (≤28 weeks gestation: 62% vs. 57%, P  = .007), and more frequently had bronchopulmonary dysplasia (BPD) (35% vs. 17%, P  = .002). Hispanic compared to Black children had higher median birth weight (2,529 g, P   〈  .001), less extreme prematurity (44%, P   〈  .001), and less BPD (21%, P  = .04). The proportion of Black children was higher (30% vs. 19%, P   〈  .001), while the proportion of Hispanic children with a tracheostomy was lower (32% vs. 42%, P  = .003) compared to the racial distribution of all pediatric admissions. Racial differences were not seen for rates of severe neurocognitive disability ( P  = .51), decannulation ( P  = .17), or death ( P  = .92) after controlling for age, sex, prematurity, and ventilator dependence. Conclusion Black children disproportionately underwent tracheostomy and had a higher comorbidity burden than White or Hispanic children. Hispanic children had proportionally fewer tracheostomies. Neurocognitive ability, decannulation, and mortality were similar for all races implying that health disparities by race may not change long‐term outcomes after pediatric tracheostomy. Laryngoscope , 132:1118–1124, 2022
    Type of Medium: Online Resource
    ISSN: 0023-852X , 1531-4995
    URL: Issue
    URL: Article
    DOI: 10.1002/lary.v132.5
    DOI: 10.1002/lary.29847
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2026089-1
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  • 9
    Online Resource
    Online Resource
    The Incidence of Pediatric Tracheostomy and Its Association Among Black Children
    Wiley ; 2021
    In:  Otolaryngology–Head and Neck Surgery Vol. 164, No. 1 ( 2021-01), p. 206-211
    Details
    In: Otolaryngology–Head and Neck Surgery, Wiley, Vol. 164, No. 1 ( 2021-01), p. 206-211
    Abstract: In 2012, Black or African American children constituted 21% of pediatric tracheostomies while representing approximately 15% of the US population. It is unclear if this discrepancy is due to differences in associated diagnoses. This study aimed to analyze the incidence of pediatric tracheostomy in the United States from 2003 to 2016 and to determine the odds of placement among Black children when compared with other children. Study Design Retrospective. Setting Academic hospital. Subjects and Methods We used the 2003 to 2016 Kid Inpatient Database to determine the incidence of pediatric tracheostomy in the United States and determine the odds of tracheostomy placement in Black children when compared with other children. Results A total of 26,034 pediatric tracheostomies were performed between 2003 and 2016, among which, 21% were Black children. The median age was 7 years (interquartile range [IQR] = 0 to 17); 43% were ≤2 years old, and 62% were male. The most common principal diagnosis was respiratory failure (72%). When compared with other children, Black children were more likely to undergo tracheostomy (odds ratio [OR] = 1.2; 95% CI, 1.1‐1.3), which increased among children younger than 2 years old (OR = 1.5; 95% CI, 1.4‐1.5). Black children with tracheostomies were also more likely to be diagnosed with laryngeal stenosis and bronchopulmonary dysplasia and to have an extended length of stay ( P 〈 . 001). Conclusion Black children are 1.2 times more likely to undergo tracheostomy in the United States compared with other children. Further investigation is warranted to evaluate if there are underlying anatomical, environmental, or psychosocial factors that contribute to this discrepancy.
    Type of Medium: Online Resource
    ISSN: 0194-5998 , 1097-6817
    URL: Article
    DOI: 10.1177/0194599820947016
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2008453-5
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  • 10
    Online Resource
    Online Resource
    Survival analysis and decannulation outcomes of infants with tracheotomies
    Wiley ; 2020
    In:  The Laryngoscope Vol. 130, No. 10 ( 2020-10), p. 2319-2324
    Details
    In: The Laryngoscope, Wiley, Vol. 130, No. 10 ( 2020-10), p. 2319-2324
    Abstract: To evaluate for differences in time to decannulation and survival rates for pediatric tracheotomy patients based on ventilator status upon discharge. Study Design Retrospective longitudinal cohort study. Methods A single‐institution longitudinal study of pediatric tracheostomy patients was conducted. Patients were categorized based on mechanical ventilation status on discharge and principal reason for tracheostomy. Survival rates were determined using the Kaplan‐Meier method. The Wilcoxon's Rank Sum test and Cox regression analysis evaluated differences in survival times and time to decannulation based on primary indication for tracheotomy and ventilation status. Results Chart review identified 305 patients who required a tracheostomy under the age of 3. The median age at the time of tracheotomy was 5.2 months. The indications for tracheotomy in these patients were airway obstruction in 145 (48%), respiratory failure in 214 (70%), and pulmonary toilet in 10 (3.3%). Seventy‐nine percent of patients were ventilator dependent at discharge. At the conclusion of the study period, 55% of patients were alive with tracheostomy in place, 30% patients were decannulated, and 15% patients were deceased. Patients with ventilator dependence at initial discharge, bronchopulmonary dysplasia, or airway obstruction were more likely to be decannulated. Hispanic patients were less likely to be decannulated. Patients had an equal probability of death regardless of ventilator status at discharge. Conclusions This study demonstrated that the time to decannulation and likelihood of decannulation varies based on the indication for the tracheostomy. The majority of patients with a tracheostomy were not decannulated at the conclusion of this study. Median time to decannulation was 2.5 years for patients with a median death time of 6 months. Level of Evidence 2b Laryngoscope , 130:2319–2324, 2020
    Type of Medium: Online Resource
    ISSN: 0023-852X , 1531-4995
    URL: Issue
    URL: Article
    DOI: 10.1002/lary.v130.10
    DOI: 10.1002/lary.28297
    Language: English
    Publisher: Wiley
    Publication Date: 2020
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