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  1. Article ; Online: Health Inequalities in the Diagnosis and Treatment of Obstructive Sleep Apnea in Children and Adults.

    Howard, Javier J M / Capasso, Robson / Ishman, Stacey L

    Otolaryngologic clinics of North America

    2024  Volume 57, Issue 3, Page(s) 353–362

    Abstract: Our understanding of the prevalence of obstructive sleep apnea (OSA) in the United States is confounded by significant inequalities in diagnosis and treatment based on gender, race and socioeconomic status. Health literacy and cultural norms contribute ... ...

    Abstract Our understanding of the prevalence of obstructive sleep apnea (OSA) in the United States is confounded by significant inequalities in diagnosis and treatment based on gender, race and socioeconomic status. Health literacy and cultural norms contribute to these inequities. Large gaps in data exist, as certain populations like Native Americans, Pacific Islanders, and sexual minorities have been sparsely studied, or not at all. Future research should aim to develop more inclusive diagnostic strategies to address OSA in diverse populations.
    MeSH term(s) Humans ; Sleep Apnea, Obstructive/diagnosis ; Sleep Apnea, Obstructive/therapy ; Sleep Apnea, Obstructive/epidemiology ; Child ; Adult ; Healthcare Disparities ; United States ; Prevalence ; Socioeconomic Factors ; Male ; Female
    Language English
    Publishing date 2024-03-13
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 417489-6
    ISSN 1557-8259 ; 0030-6665
    ISSN (online) 1557-8259
    ISSN 0030-6665
    DOI 10.1016/j.otc.2024.02.004
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  2. Article ; Online: Sleep Renewed: Innovations in Sleep Apnea Care for Adults and Children.

    Ishman, Stacey L / Li, Carol / Dhanda Patil, Reena

    Otolaryngologic clinics of North America

    2024  Volume 57, Issue 3, Page(s) xv–xvi

    MeSH term(s) Humans ; Child ; Adult ; Sleep Apnea Syndromes/therapy ; Sleep Apnea, Obstructive/therapy
    Language English
    Publishing date 2024-03-08
    Publishing country United States
    Document type Editorial ; Introductory Journal Article
    ZDB-ID 417489-6
    ISSN 1557-8259 ; 0030-6665
    ISSN (online) 1557-8259
    ISSN 0030-6665
    DOI 10.1016/j.otc.2024.02.018
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  3. Article ; Online: Persistent Obstructive Sleep Apnea Burden on Family Finances and Quality of Life.

    Bergeron, Mathieu / Ishman, Stacey L

    Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery

    2021  Volume 165, Issue 3, Page(s) 483–489

    Abstract: Objective: We previously found that financial concerns negatively affect the quality of life of families of children with persistent obstructive sleep apnea (OSA) after tonsillectomy. The goal is to quantify the financial impact on families of children ... ...

    Abstract Objective: We previously found that financial concerns negatively affect the quality of life of families of children with persistent obstructive sleep apnea (OSA) after tonsillectomy. The goal is to quantify the financial impact on families of children with persistent OSA and assess contributing factors.
    Study design: Cross-sectional survey study with comparison group.
    Setting: Upper airway center at a tertiary pediatric hospital.
    Methods: Participants included consecutive children with persistent OSA from September to October 2017. Healthy children seen in a general otolaryngology clinic served as controls. Families of both groups completed the Family Impact Questionnaire and the modified Comprehensive Score for Financial Toxicity (COST).
    Results: Families of the 50 patients (25 study and 25 control) completed the surveys: the mean age was 6.4 years (95% CI, 5.0-7.8), and 19 (38%) were female. There were no differences in age, sex, race, or insurance status between groups (
    Conclusion: Families of children with persistent OSA reported a high financial burden related to their children's disease and were more likely to report financial toxicity than families of controls. Concern regarding missed work and school associated with appointments and treatment was a significant factor.
    MeSH term(s) Case-Control Studies ; Child ; Down Syndrome/complications ; Female ; Financing, Personal/economics ; Humans ; Male ; Quality of Life ; Sleep Apnea, Obstructive/economics ; Sleep Apnea, Obstructive/physiopathology ; Surveys and Questionnaires
    Language English
    Publishing date 2021-01-19
    Publishing country England
    Document type Journal Article
    ZDB-ID 392085-9
    ISSN 1097-6817 ; 0161-6439 ; 0194-5998
    ISSN (online) 1097-6817
    ISSN 0161-6439 ; 0194-5998
    DOI 10.1177/0194599820986566
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  4. Article ; Online: In response to Impact of Insomnia on Hypoglossal Nerve Stimulation Outcomes in the ADHERE Registry.

    Dhanda Patil, Reena / Ishman, Stacey L / Chang, Jolie L / Thaler, Erica / Suurna, Maria V

    The Laryngoscope

    2024  

    Language English
    Publishing date 2024-03-21
    Publishing country United States
    Document type Letter
    ZDB-ID 80180-x
    ISSN 1531-4995 ; 0023-852X
    ISSN (online) 1531-4995
    ISSN 0023-852X
    DOI 10.1002/lary.31412
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  5. Article ; Online: The Role of Sleep Studies in Children Who Snore.

    Ishman, Stacey L

    JAMA otolaryngology-- head & neck surgery

    2016  Volume 142, Issue 2, Page(s) 179–181

    Abstract: Hypothesis: Sleep studies (ie, polysomnography) should be used in children who snore and exhibit symptoms of sleep-disordered breathing (SDB) to determine the presence and severity of obstructive sleep apnea (OSA). ...

    Abstract Hypothesis: Sleep studies (ie, polysomnography) should be used in children who snore and exhibit symptoms of sleep-disordered breathing (SDB) to determine the presence and severity of obstructive sleep apnea (OSA).
    MeSH term(s) Child ; Comorbidity ; Humans ; Polysomnography ; Practice Guidelines as Topic ; Risk Factors ; Severity of Illness Index ; Sleep Apnea Syndromes/diagnosis ; Sleep Apnea Syndromes/physiopathology ; Snoring/diagnosis ; Snoring/physiopathology
    Language English
    Publishing date 2016-02
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2701825-8
    ISSN 2168-619X ; 2168-6181
    ISSN (online) 2168-619X
    ISSN 2168-6181
    DOI 10.1001/jamaoto.2015.1
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  6. Article ; Online: Management of Live Insects in the External Auditory Canal: A Wilderness Perspective.

    Giltmier, Andrew / Aunins, Benjamin / Ishman, Stacey L / Roche, Conal

    Wilderness & environmental medicine

    2022  Volume 33, Issue 3, Page(s) 318–323

    Abstract: A live insect within the external auditory canal is an unpleasant possibility during wilderness recreation. To our knowledge, no study has attempted to quantify the risk of this event occurring in the wilderness. However, such events anecdotally seem to ... ...

    Abstract A live insect within the external auditory canal is an unpleasant possibility during wilderness recreation. To our knowledge, no study has attempted to quantify the risk of this event occurring in the wilderness. However, such events anecdotally seem to occur with some regularity in a variety of climates. Most cases are benign, but a small subset of patients can develop complications including infection, hearing loss, and vestibular complaints related to the foreign body. In the emergency department or clinic, removal of the insect is a simple procedure in most circumstances; however, the material and expertise required for backcountry removal of the insect are often limited. With this consideration in mind, we offer a conservative approach to backcountry insect removal based on a selective review of the published literature on this topic. Where published data are lacking, we make recommendations based on anecdotal experience of the authors dealing with this condition in austere environments and in the emergency department. We recommend insect removal only if the patient is acutely symptomatic and the insect is visualized and graspable with the instrument used for removal. In any other circumstance, intervention should be deferred until definitive care is reached because of risks of complications associated with removal, including infection, bleeding, and tympanic membrane damage.
    MeSH term(s) Animals ; Ear Canal ; Emergency Service, Hospital ; Foreign Bodies ; Humans ; Insecta
    Language English
    Publishing date 2022-05-27
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1238909-2
    ISSN 1545-1534 ; 1080-6032
    ISSN (online) 1545-1534
    ISSN 1080-6032
    DOI 10.1016/j.wem.2022.03.013
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  7. Article ; Online: Relationship of Nocturnal Insomnia Symptoms and Outcomes After Hypoglossal Nerve Stimulation.

    Dhanda Patil, Reena / Suurna, Maria V / Steffen, Armin / Soose, Ryan / Coxe, James / Chan, Teresa / Ishman, Stacey L

    OTO open

    2024  Volume 8, Issue 2, Page(s) e134

    Abstract: Objective: In patients undergoing hypoglossal nerve stimulation (HGNS), we examined the Insomnia Severity Index (ISI) to understand how baseline sleep onset insomnia (SOI), sleep maintenance insomnia (SMI), and early morning awakening (EMA) affected ... ...

    Abstract Objective: In patients undergoing hypoglossal nerve stimulation (HGNS), we examined the Insomnia Severity Index (ISI) to understand how baseline sleep onset insomnia (SOI), sleep maintenance insomnia (SMI), and early morning awakening (EMA) affected postsurgical outcomes.
    Study design: Observational.
    Setting: Multicenter registry.
    Methods: We included patients from the Adherence and Outcomes of Upper Airway Stimulation for Obstructive Sleep Apnea International Registry (ADHERE) with a baseline ISI from 2020 to 2023. Regression analysis examined the association of ISI question scores for SOI, SMI, and EMA and outcomes: Apnea-Hypopnea Index (AHI) reduction, device usage, changes in the Epworth Sleepiness Scale (ESS) and overall ISI score, final visit (FV) completion, and satisfaction.
    Results: No relationship was noted between insomnia subtypes and AHI reduction or FV completion. In the subgroup of patients with baseline moderate/severe insomnia, patients with major impairment for SOI used their device 64 min/day longer than those with minimal impairment. Among all patients, those with baseline major impairment for SOI had a 2.3 points greater improvement in ISI from baseline to FV compared to patients with minimal impairment, while patients with baseline major impairment for SMI had a 2.0 and 3.5 points greater improvement in the ESS and ISI than those with minimal impairment. Patients with EMA and moderate/severe baseline insomnia had decreased odds of being satisfied after surgery.
    Conclusion: In ADHERE, nocturnal symptoms of insomnia did not limit HGNS efficacy or therapy use. Conversely, those with worse insomnia subtype impairments at baseline had improved outcomes related to adherence, sleepiness, and insomnia at the FV.
    Language English
    Publishing date 2024-04-21
    Publishing country United States
    Document type Journal Article
    ISSN 2473-974X
    ISSN (online) 2473-974X
    DOI 10.1002/oto2.134
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  8. Article ; Online: Impact of Insomnia on Hypoglossal Nerve Stimulation Outcomes in the ADHERE Registry.

    Dhanda Patil, Reena / Ishman, Stacey L / Chang, Jolie L / Thaler, Erica / Suurna, Maria V

    The Laryngoscope

    2023  Volume 134, Issue 1, Page(s) 471–479

    Abstract: Objective: We aimed to determine the preoperative prevalence of insomnia in the Adherence and Outcomes of Upper Airway Stimulation for OSA International Registry (ADHERE) and to examine serial sleep-related data longitudinally, in particular the ... ...

    Abstract Objective: We aimed to determine the preoperative prevalence of insomnia in the Adherence and Outcomes of Upper Airway Stimulation for OSA International Registry (ADHERE) and to examine serial sleep-related data longitudinally, in particular the Insomnia Severity Index (ISI), to compare outcomes between patients with no/subthreshold insomnia (ISI < 15) and moderate/severe insomnia (ISI ≥ 15) at baseline.
    Methods: We analyzed observational data from ADHERE between March 2020 and September 2022. Baseline demographic and mental health (MH) data, apnea hypopnea index (AHI), ISI, and ESS (Epworth Sleepiness Scale) were recorded. At post-titration (PT) and final visits, AHI, ISI, ESS and nightly usage were compared between baseline ISI < 15 and ISI ≥ 15 subgroups.
    Results: A baseline ISI was obtained in 928 patients (62% with ISI ≥ 15). Of the 578 and 141 patients reaching the 12- and 24-month time periods to complete PT and final visits, 292 (50.5%) and 91 (64.5%) completed the ISI, respectively. Baseline MH conditions were higher with ISI ≥ 15 than ISI < 15 (p < 0.001). AHI reduction and adherence did not differ between patients with baseline ISI ≥ 15 and ISI < 15. Patients with ISI ≥ 15 experienced greater improvement in ESS than ISI < 15 at post-titration and final visits (p = 0.014, 0.025). All patients had improved nocturnal, daytime, and overall ISI scores at follow-up visits (p < 0.001), especially for those with baseline ISI ≥ 15 compared with ISI < 15 (p < 0.05).
    Conclusion: HGNS therapy efficacy and adherence were similar between ISI severity subgroups at follow-up visits. Insomnia and sleepiness scores improved in all patients with HGNS therapy and to a greater degree in patients with baseline moderate/severe insomnia.
    Level of evidence: 4 Laryngoscope, 134:471-479, 2024.
    MeSH term(s) Humans ; Electric Stimulation Therapy ; Hypoglossal Nerve ; Registries ; Sleep Apnea, Obstructive/surgery ; Sleep Initiation and Maintenance Disorders/epidemiology ; Sleep Initiation and Maintenance Disorders/etiology ; Sleep Initiation and Maintenance Disorders/therapy ; Sleepiness ; Treatment Outcome
    Language English
    Publishing date 2023-08-10
    Publishing country United States
    Document type Comparative Study ; Journal Article ; Observational Study
    ZDB-ID 80180-x
    ISSN 1531-4995 ; 0023-852X
    ISSN (online) 1531-4995
    ISSN 0023-852X
    DOI 10.1002/lary.30933
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  9. Article ; Online: Hypoglossal Nerve Stimulation in Veterans With Comorbid Insomnia and Sleep Apnea.

    Dhanda Patil, Reena / Hong, Michael P / Ishman, Stacey L

    Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery

    2021  Volume 164, Issue 6, Page(s) 1345–1353

    Abstract: Objective: Insomnia and sleep apnea frequently co-occur, with additive effects of both disorders presenting clinicians with unique treatment challenges compared to one disorder alone. The hypoglossal nerve stimulator (HNS) is a promising treatment for ... ...

    Abstract Objective: Insomnia and sleep apnea frequently co-occur, with additive effects of both disorders presenting clinicians with unique treatment challenges compared to one disorder alone. The hypoglossal nerve stimulator (HNS) is a promising treatment for patients with comorbid insomnia and sleep apnea (COMISA), many of whom have positive airway pressure (PAP) intolerance. Our aim was to determine adherence to and efficacy of HNS in veterans with COMISA refractory to PAP therapy compared to those with obstructive sleep apnea alone (OSA only).
    Study design: Retrospective case series.
    Setting: A single, academic Veterans Affairs medical center.
    Methods: Review of clinical records, pre- and postoperative polysomnography, and clinical measures of obstructive sleep apnea (OSA), sleepiness, and insomnia was conducted in 53 consecutive cases of veterans with OSA undergoing HNS implantation. HNS adherence was obtained at postoperative visits. HNS adherence and efficacy were compared between individuals with COMISA and OSA only.
    Results: COMISA was noted in 30 of 53 (56.6%) veterans studied. There was no significant difference between HNS adherence in patients with COMISA and OSA only (5.6 vs 6.4 h/night,
    Conclusion: HNS was successful in treating a complex veteran population with COMISA refractory to PAP when examining measures of treatment adherence and efficacy. Future studies of patients with COMISA undergoing HNS will examine effective combination therapy targeting insomnia and a multidisciplinary effort to optimize treatment adherence.
    MeSH term(s) Aged ; Electric Stimulation Therapy ; Female ; Humans ; Hypoglossal Nerve ; Male ; Middle Aged ; Retrospective Studies ; Sleep Apnea, Obstructive/complications ; Sleep Apnea, Obstructive/therapy ; Sleep Initiation and Maintenance Disorders/complications ; Sleep Initiation and Maintenance Disorders/therapy ; United States ; Veterans Health Services
    Language English
    Publishing date 2021-01-05
    Publishing country England
    Document type Journal Article
    ZDB-ID 392085-9
    ISSN 1097-6817 ; 0161-6439 ; 0194-5998
    ISSN (online) 1097-6817
    ISSN 0161-6439 ; 0194-5998
    DOI 10.1177/0194599820982638
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  10. Article ; Online: Rapid maxillary expansion in paediatric obstructive sleep apnoea - Authors' reply.

    Ersu, Refika / Chen, Maida L / Ehsan, Zarmina / Ishman, Stacey L / Redline, Susan / Narang, Indra

    The Lancet. Respiratory medicine

    2023  Volume 11, Issue 5, Page(s) e46

    MeSH term(s) Child ; Humans ; Palatal Expansion Technique ; Sleep Apnea, Obstructive/therapy
    Language English
    Publishing date 2023-04-17
    Publishing country England
    Document type Letter ; Comment
    ZDB-ID 2686754-0
    ISSN 2213-2619 ; 2213-2600
    ISSN (online) 2213-2619
    ISSN 2213-2600
    DOI 10.1016/S2213-2600(23)00139-X
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