Comorbid Insomnia and Sleep Apnea: Challenges and Treatments.

Insomnia and obstructive sleep apnea (OSA) are 2 of the most prevalent sleep disorders and frequently co-occur. Cognitive behavioral therapy for insomnia is the first line treatment for insomnia and has been shown to improve compliance with positive airway pressure therapy. Other alternatives to OSA treatment may have higher acceptance in those with comorbid insomnia and sleep apnea (COMISA).

Comorbid Insomnia and Sleep Apnea: Challenges and Treatments.

Insomnia and obstructive sleep apnea (OSA) are 2 of the most prevalent sleep disorders and frequently co-occur. Therapy can be challenging as treatment of 1 disease may worsen the other. Cognitive behavioral therapy for insomnia is the first-line treatment for insomnia and has been shown to improve compliance with positive airway pressure therapy.

Local Effect of Ballistic Fragments Embedded Along the Carotid Sheath of a Porcine Animal Model.

Introduction: Energized ballistic fragments from improvised explosive devices were the most common cause of injury to coalition service personnel during conflicts in Iraq and Afghanistan. Surgical excision of retained fragments is not routinely performed unless there is a concern for injury to vital structures. However, no clear guidelines dictate when or if a fragment should be removed, reflecting a lack of objective evidence of their long-term effects.

Making a Major Change: Changing Your Practice Setting, Retirement, and Locums.

The goal of this article is to discuss factors associated with career change and give data and recommendations of how to prepare for a career change in regards to early, mid, and late career.

The effect of postoperative steroid dosing on readmission rates following radiofrequency ablation tonsillectomy.

Objective: To examine the effect of postoperative steroid dosage on postoperative telephone calls, emergency department (ED) visits, and hemorrhage rates for two groups receiving different steroid dosing following radiofrequency ablation tonsillectomy.

Study Design: Retrospective chart review between January 1, 2014 and January 1, 2019.

Setting: Tertiary care pediatric hospital.

Head Face and Neck Surgical Workload From a Contemporary Military Role 3 Medical Treatment Facility.

Introduction: Previous analyses of head, face, and neck (HFN) surgery in the deployed military setting have focused on the treatment of injuries using trauma databases. Little has been written on the burden of disease and the requirement for follow-up care. The aim of this analysis was to provide the most comprehensive overview of surgical workload in a contemporary role 3 MTF to facilitate future planning.

Accelerated versus delayed initiation of renal-replacement strategies following cardiac surgery.

Visual representation of the impact and controversy surrounding the timing of initiation for renal-replacement therapy for acute kidney injury after cardiac surgery. On the of the image is the impact of acute kidney injury on postoperative heart surgery patients. On the are the considerations a provider must undertake when determining the appropriating timing for renal-replacement therapy for individual patients.

Hypoglossal Nerve Stimulation: Outcomes in Veterans with Obstructive Sleep Apnea and Common Comorbid Post-traumatic Stress Disorder.

Objectives/hypothesis: Veterans have an increasing prevalence of obstructive sleep apnea (OSA) and high levels of intolerance to positive airway pressure (PAP). The hypoglossal nerve stimulator (HNS) is a promising alternative surgical treatment for OSA in these patients, many of whom suffer from mental health conditions such as post-traumatic stress disorder (PTSD) that may negatively affect their ability to use PAP. Our aims were: 1) to assess postoperative changes in OSA severity and sleepiness in a veteran only population after HNS; 2) to compare postoperative changes in OSA severity, sleepiness and HNS adherence between veterans with and without PTSD; and 3) to compare HNS adherence in our population to HNS adherence in the current literature as well as published PAP adherence data.

Polysomnographic Outcomes After Observation for Mild Obstructive Sleep Apnea in Children Younger Than 3 Years.

Objective: Mild obstructive sleep apnea (OSA), particularly in young children, is often treated with observation. However, there is little evidence regarding the outcomes with this approach. Our aim was to assess the impact of observation on sleep for children aged <3 years with mild OSA.

Sleep Apnea Treatment Considerations in Patients with Comorbidities.

A wide range of sleep, psychiatric, and medical comorbidities can present with obstructive sleep apnea (OSA), complicating treatment because of intolerance or low adherence to traditional modalities of therapy. Providers must have heightened awareness of how these comorbidities can affect their patients' OSA and work together as a team to optimize health and well-being in this complex population.

Children with Down syndrome and mild OSA: treatment with medication versus observation.

Study Objectives: Children with Down syndrome (DS) have a high prevalence of obstructive sleep apnea (OSA). Anti-inflammatory medications have been shown to be an effective treatment for mild OSA in otherwise healthy children. However, the efficacy in children with DS and mild OSA has not been investigated.

Hypoglossal Nerve Stimulation in Veterans with Obstructive Sleep Apnea.

Objectives: The hypoglossal nerve stimulator (HNS) is an effective treatment for obstructive sleep apnea (OSA) in a relatively healthy subset of the population. Our aim was to determine the efficacy of HNS in a veteran population with a high incidence of chronic disease and mental health disorders. Our secondary aim was to compare subjective outcomes and adherence between veterans with and without mental health disorders.

Outcomes in children with down syndrome and mild obstructive sleep apnea treated non-surgically.

Objectives: Nasal steroids, oral anti-leukotrienes and supplemental oxygen are effective in the treatment of mild obstructive sleep apnea (OSA) in otherwise healthy children. However, their efficacy is unknown in children with Down syndrome (DS). Here we examine the effect of single medication therapy versus observation versus oxygen on polysomnographic outcomes in these children.

Sleep-Disordered Breathing in Pediatric Patients With Rett Syndrome.

Study Objectives: Although respiratory abnormalities occurring during wakefulness are well recognized in patients with Rett syndrome (RS), less has been reported regarding sleep-disordered breathing (SDB) in this population. This study aims to characterize the presenting complaints, types and severity of SDB, and treatment modalities of patients with RS and sleep concerns.

Methods: Retrospective chart review of pediatric patients with RS referred to our academic tertiary care institution from January 2007 to July 2017.

Effects of Medical Therapy on Mild Obstructive Sleep Apnea in Adult Patients.

Study Objectives: Patients with obstructive sleep apnea (OSA) have been shown to have high levels of inflammatory markers. Anti-inflammatory treatment with montelukast and intranasal steroids have demonstrated efficacy for mild OSA in children; this has not been fully evaluated in adults. This study investigated the response of mild OSA in adults to anti-inflammatory medical therapy.

Hypoglossal Nerve Stimulator Outcomes for Patients Outside the U.S. FDA Recommendations.

Objectives: The hypoglossal nerve stimulator (HGNS) is currently approved for the treatment of obstructive sleep apnea (OSA) in patients with an apnea-hypopnea index (AHI) of >15 to ≤65 events/hour, and a central apnea index (CAI) <25% of the AHI, no complete concentric collapse on drug-induced sleep endoscopy, and a recommended body mass index (BMI) <32 kg/m . We present 18 patients implanted as a salvage procedure despite being outside these guidelines.

Methods: We included all patients who underwent HGNS but who did not meet all FDA guidelines.

Diagnosis and perioperative management in pediatric sleep-disordered breathing.

Sleep-disordered breathing has a prevalence of 12% in the pediatric population. It represents a spectrum of disorders encompassing abnormalities of the upper airway that lead to sleep disruption, including primary snoring, obstructive sleep apnea, central sleep apnea, and sleep-related hypoventilation. Sleep-disordered breathing is the most common indication for adenotonsillectomy, one of the most common procedures performed in children.

Surgical relationship of the nasolacrimal system to the maxillary line: Performing safe mega antrostomy.

Background: Endoscopic extended maxillary mega-antrostomy (EMMA) is a mucosal sparing technique that allows maxillary drainage by gravity, with a reported symptomatic nasolacrimal duct injury incidence of 0-4%, based on history alone. Injury to the nasolacrimal duct is known to cause epiphora, a complication that is rare but more often seen in this revision surgery.

Objective: The goal of this study was to determine the incidence of nasolacrimal system penetration during EMMA.

Sinus penetration of saline solution irrigation and atomizer in a cadaveric polyp and allergic fungal sinusitis model.

Allergic fungal sinusitis (AFS) is a stubborn disease requiring surgical and medical management. Delivery of topical medication is paramount in these patients, but the most difficult to accomplish. We investigated heavy irrigation (nasal douche) and atomized medication delivery potential in a cadaveric sinus model of polypoid AFS disease.

Approaching chronic sinusitis.

Chronic sinusitis is a common disease that encompasses a number of syndromes that are characterized by sinonasal mucosal inflammation. Chronic sinusitis can be defined as two or more of the following symptoms lasting for more than 12 consecutive weeks: discolored rhinorrhea, postnasal drip, nasal obstruction, facial pressure or pain, or decreased sense of smell. Chronic sinusitis is further classified as chronic sinusitis with polyposis, chronic sinusitis without polyposis, or allergic fungal sinusitis using physical examination, and histologic and radiographic findings.

Do U.S. medical licensure examination step 1 scores correlate with council on resident education in obstetrics and gynecology in-training examination scores and American board of obstetrics and gynecology written examination performance?

Objective: The purpose of this study was to assess the possible association between scores of >200 on U.S. Medical Licensure Examination (USMLE) step 1 and the Council on Resident Education in Obstetrics and Gynecology (CREOG) in-training examinations and the pass rate on the American Board of Obstetrics and Gynecology (ABOG) written examination.