Baptista-Jardin, P. (Peter)
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- Myofunctional therapy app for severe apnea-hypopnea sleep obstructive syndrome: Pilot randomized controlled trial(2020) Garcia-Iriarte, M.T. (Maria Teresa); Casado-Morente, J.C. (Juan Carlos); Barrios, V.I. (Victoria Ignacio); Plaza, G. (Guillermo); O’Connor-Reina, C. (Carlos); Baptista-Jardin, P. (Peter); Rodriguez-Ruiz, E. (Elisa); Morillo-Dominguez, M.C. (Maria-Del-Carmen); Garcia, J.M.I. (José Maria Ignacio)Background: Myofunctional therapy has demonstrated efficacy in treating sleep-disordered breathing. We assessed the clinical use of a new mobile health (mHealth) app that uses a smartphone to teach patients with severe obstructive sleep apnea–hypopnea syndrome (OSAHS) to perform oropharyngeal exercises. Objective: We conducted a pilot randomized trial to evaluate the effects of the app in patients with severe OSAHS. Methods: Forty patients with severe OSAHS (apnea–hypoxia index [AHI]>30) were enrolled prospectively and randomized into an intervention group that used the app for 90 sessions or a control group. Anthropometric measures, Epworth Sleepiness Scale (0-24), Pittsburgh Sleep Quality Index (0-21), Iowa Oral Performance Instrument (IOPI) scores, and oxygen desaturation index were measured before and after the intervention. Results: After the intervention, 28 patients remained. No significant changes were observed in the control group; however, the intervention group showed significant improvements in most metrics. AHI decreased by 53.4% from 44.7 (range 33.8-55.6) to 20.88 (14.02-27.7) events/hour (P<.001). The oxygen desaturation index decreased by 46.5% from 36.31 (27.19-43.43) to 19.4 (12.9-25.98) events/hour (P=.003). The IOPI maximum tongue score increased from 39.83 (35.32-45.2) to 59.06 (54.74-64.00) kPa (P<.001), and the IOPI maximum lip score increased from 27.89 (24.16-32.47) to 44.11 (39.5-48.8) kPa (P<.001). The AHI correlated significantly with IOPI tongue and lip improvements (Pearson correlation coefficient −0.56 and −0.46, respectively; both P<.001). The Epworth Sleepiness Scale score decreased from 10.33 (8.71-12.24) to 5.37 (3.45-7.28) in the app group (P<.001), but the Pittsburgh Sleep Quality Index did not change significantly. Conclusions: Orofacial exercises performed using an mHealth app reduced OSAHS severity and symptoms, and represent a promising treatment for OSAHS. Trial Registration: Spanish Registry of Clinical Studies AWGAPN-2019-01, ClinicalTrials.gov NCT04438785; https://clinicaltrials.gov/ct2/show/NCT04438785
- Could the use of a new novel bipolar radiofrequency device (Aerin) improve nasal valve collapse? A systematic review and meta-analysis(2023) Lugo, R. (Rodolfo); Pierri, M. (Michelangelo); Jacobowitz, O. (Ofer); Mofa, A. (Antonio); Baptista-Jardin, P. (Peter); Giorgi, L. (Lucrezia); Casale-Falcone, M. (Manuele)BackgroundSurgical treatment for nasal obstruction caused by nasal valve collapse requires a significant recovery period and risks of complications, while nasal dilators are uncomfortable. Recently, radiofrequency treatment of lateral walls has been used under local anesthesia as an office base surgery. This work aims to assess the efficacy of a new radiofrequency device, the Vivaer (TM) System (Aerin Medical, Sunnyvale, CA), to treat nasal obstruction through a systematic review and meta-analysis.MethodsTwo researchers independently reviewed the literature up to December 2021. Studies on patients seeking treatment for nasal obstruction due to nasal valve collapse were included in the analysis.ResultsFour studies (218 patients) met the inclusion criteria and treated the nasal valve regions bilaterally with the Aerin Medical Vivaer (TM) System. After the treatment, the NOSE score was reduced at three months postoperatively. Minor adverse events were reported in the included studies, and two showed no complications. None of the studies reported changes in the external appearance of the nose.ConclusionThe radiofrequency treatment using the Vivaer device can be useful for treating nasal valve collapse, improving significantly subjective breathing symptom scores. Further studies on a large scale are needed to confirm these results.
- Potential Use of Vivascope for real-time histological evaluation in endoscopic laryngeal surgery(2023) Di-Giovanni, S. (Simone); Moffa, A. (Antonio); Crescenzi, A. (Anna); Baptista-Jardin, P. (Peter); Giorgi, L. (Lucrezia); Verri, M. (Martina); Taffon, C. (Chiara); Casale-Falcone, M. (Manuele); De-Benedetto, L. (Luigi)We aimed to assess the feasibility of using confocal laser scanning microscopy (CLSM) for the real-time ex vivo examination of histological samples of laryngeal lesions and to evaluate the correlation between CLSM and definitive histological results. This preliminary study included eight consecutive patients with suspected laryngeal lesions who were candidates for endoscopic laryngeal surgery. The obtained samples were evaluated using CLSM and classified as inadequate or adequate (high- and low-grade dysplasia, in situ and invasive carcinoma, positive surgical margin, and inflammatory outbreaks). CLSM showed the macro image in all cases and generated a digital version. All the samples were defined as adequate during CLSM and confirmed at histopathology: low-grade dysplasia (n = 5), low- and high-grade dysplasia (n = 2), and high-grade dysplasia (n = 1). Four samples had an involved resection margin, and three samples revealed the presence of inflammatory outbreaks. CLSM can be applied to larynx pathology with excellent agreement with final histological results.
- Comparison of intranasal steroid application using nasal spray and spray-sol to treat allergic rhinitis: a preliminary investigation(2023) Lugo, R. (Rodolfo); Carnuccio, L. (Luca); Moffa, A. (Antonio); Baptista-Jardin, P. (Peter); Giorgi, L. (Lucrezia); Casale-Falcone, M. (Manuele)Allergic Rhinitis (AR) is a chronic inflammatory disease of sino-nasal mucosa, is IgE-mediated, and affects 10-40% of the global population. This study aimed to compare the efficacy of nasal administration of Beclomethasone Dipropionate (BDP) delivered via Spray-sol with nasal spray in patients suffering from AR. We included 28 AR patients assigned to one of the two following treatments: the Spray-sol group (BDP via Spray-sol) (n = 13) and the spray group (BDP using a common nasal spray) (n = 15). Both treatments were administered twice daily for 4 weeks. A nasal endoscopy evaluation and Total Nasal Symptom Score were performed at baseline and after treatment. The Spray-sol group showed better results than the spray group regarding nasal endoscopy (edema, p < 0.01; irritation, p < 0.01; secretion, p < 0.01) and nasal symptoms (nasal congestion, p < 0.05; rhinorrhea, p < 0.05; sneezing, p < 0.05; and total score, p < 0.05). No side effects were recorded. These data supported the fact that the use of BDP delivered with Spray-sol is more effective than BDP nasal spray in AR patients. Further studies are needed to confirm these encouraging results.
- Obstructive sleep apnea syndrome: from phenotype to genetic basis(2009) Rinaldi, V. (V.); Baptista-Jardin, P. (Peter); Casale-Falcone, M. (Manuele); Salvinelli, F. (F.); Bressi, F. (F.); Pappacena, M. (M.)Obstructive sleep apnea syndrome (OSAS) is a complex chronic clinical syndrome, characterized by snoring, periodic apnea, hypoxemia during sleep, and daytime hypersomnolence. It affects 4-5% of the general population. Racial studies and chromosomal mapping, familial studies and twin studies have provided evidence for the possible link between the OSAS and genetic factors and also most of the risk factors involved in the pathogenesis of OSAS are largely genetically determined. A percentage of 35-40% of its variance can be attributed to genetic factors. It is likely that genetic factors associated with craniofacial structure, body fat distribution and neural control of the upper airway muscles interact to produce the OSAS phenotype. Although the role of specific genes that influence the development of OSAS has not yet been identified, current researches, especially in animal model, suggest that several genetic systems may be important. In this chapter, we will first define the OSAS phenotype, the pathogenesis and the risk factors involved in the OSAS that may be inherited, then, we will review the current progress in the genetics of OSAS and suggest a few future perspectives in the development of therapeutic agents for this complex disease entity.
- Defining epiglottic collapses patterns in obstructive sleep apnea patients: Francia-Lugo classification(2023) Lugo, R. (Rodolfo); Di-Giovanni, S. (Simone); Iafrati, F. (Francesco); Moffa, A. (Antonio); Francia, C. (Carlos); Baptista-Jardin, P. (Peter); Giorgi, L. (Lucrezia); Casale-Falcone, M. (Manuele)Obstructive Sleep Apnea (OSA) is characterized by repetitive collapse of the upper airway during sleep. Drug-Induced Sleep endoscopy (DISE) is used to identify the collapse site. Among the possible sites of collapse, the epiglottis occurs more frequently than previously described. In this study, we reviewed DISE findings and classified different epiglottic collapse patterns. We found 104 patients (16.4%) with epiglottis collapse (primary 12.5% and secondary 3.9%). We described the following patterns of epiglottis collapse: Anterior-Posterior (AP) collapse with rigid component trapdoor type (48%); AP collapse with lax component floppy type (13.5%); Lateral- Lateral (LL) collapse with omega shape component book type (14.5%); and secondary due to lateral pharyngeal wall or tongue base collapse (24%). The identification of the epiglottic collapse pattern is crucial in decision-making when attempting to ameliorate OSA. These findings in OSA phenotyping could influence the type of treatment chosen.
- Quality of life impact of hypoglossal nerve stimulation with inspire (R) device in patients with obstructive sleep apnea intolerant to continuous positive airway pressure therapy(2022) Sánchez-Olivieri, I. (Isabel); Plaza, G. (Guillermo); O’Connor-Reina, C. (Carlos); Alcalde, J. (Juan); Baptista-Jardin, P. (Peter); Urrestarazu, E. (Elena); Alegre-Esteban, M. (Manuel); Di-Frisco, I.M. (Isberling Madeleine)Patients with obstructive sleep apnea (OSA) that do not tolerate/accept continuous positive airway pressure (CPAP) are candidates for surgical alternatives. Hypoglossal nerve stimulation (HNS) through the implantation of the Inspire (R) device constitutes a minimally invasive operative option. The main objective of this study is to estimate, under real-world clinical practice conditions, the 3-month impact on the quality of life (IQoL) of the HNS in patients with moderate/severe OSA who do not tolerate or accept CPAP, compared to patients who did not receive HNS. As a baseline, the unadjusted EuroQol utility index was 0.764 (SD:0.190) in the intervention group (IGr) and 0.733 (SD:0.205) in the control group (CGr); three months later, the indexes were 0.935 (SD: 0.101) and 0.727 (SD:0.200), respectively. The positive impact on quality of life was estimated to be +0.177 (95% CI: 0.044-0.310; p = 0.010). All dimensions in the IGr improved compared to CGr, especially for usual activities (p < 0.001) and anxiety/depression (p > 0.001). At the end of the follow-up, there was no significant difference in the quality of life between the general Spanish population and the IGr (difference: 0.012; CI95%: -0.03 to -0.057; p = 0.0578) for the same age range; however, there was a difference concerning the CGr (difference: -0.196; CI95%: -0.257 to -0.135; p < 0.001). In conclusion, patients with moderate/severe OSA implanted with the Inspire (R) device showed a positive IQoL.