Review of the Literature

Literature Review
Justina Musa
Professor: Lawson
NRS 441
Date: 5/13/2014
Review of literature
Article 1: American Academy of Otolaryngology. (2011). Surgery for Obstructive Sleep Apnea.
The article delves into obstructive sleep apnea (OSA), prevalence, with 1 in 5 Americans having mild OSA, surgical treatments including skeletal procedures and non surgical methods. The organization also highlight the condition’s impact on health including increased risk of stroke, heart diseases and breathing obstruction during the night which in turn increases sleepiness during the day. Thus, one of the treatments adopted is surgery of the nose to reduce blockage and snoring, as well as the upper throat and lower throat. Skeletal procedure is mostly used for patients with structural and development alterations of the jaws (American Academy of Otolaryngology 2011). Non surgical procedures include continuous positive airway pressure (CPAP) weight loss and oral appliances. The article’s main strength is that it provides an over view of the condition, and what patients should do before resulting to surgery.
Article 2: Morgan, C., & Meyers, A. (2013). Surgical Approach to Snoring and Sleep Apnea. Medscape
The authors highlight on the surgical management of sleep apnea and snoring, and since OSA has obstruction it can present challenges to surgeons. Though, there are numerous surgical procedures to manage OSA, uvulopalatopharyngoplasty (UPPP, or UP3 is the most commonly used procedure. Patients typically require surgery when the source of the abnormality is correctable after the patient has already used CPAP. Morgan &Meyers (2013) point out, patients do not require scanning as this result to unnecessary radiation and does not add value. The main strength of the article is that it delves into various s surgical procedures useful for patients with OSA, and also highlights on possible complications and care required for patients who have undergone surgery. Post obstructive pulmonary edema, bleeding and injuries are possible complications that patients should be aware about, and patients with mild obstructive diseases respond more to surgical management than severally ill patients.
Article 3: Mehra, P., & Wolford, L. M. (2009). Surgical Management of Obstructive Sleep Apnea. Baylor University Medical Centre; 13(4): 338-342.
OSA has garnered attention among medical practitioners because of the potential impact of the condition. In particular, both sleep fragmentation and hypoxemia result from airway blockage which then precipitate apnea or hypopnea. Mehra and Wolford (2009) lay emphasis on various surgical techniques form managing OSA, but focus more jaw advancement surgical procedures. Besides focusing on the various surgical procedures, the authors highlight on presurgical considerations including planning including correction of craniofacial deformities, skeletal and soft tissue, together with medical evaluation and data analysis on the patient. The authors studied the results of othognathic surgery performed in 72 patients under the care of Dr. Wolford. Though some patients did not have OSA they had some form of dentofacial deformities. After conducting follow up tests on the patients none had significant symptoms showing that surgical intervention was effective. The article sheds light on the effectiveness of surgery among patients with craniofacial deformities and can reduce complications from the conditions.
Article 4: Weaver, E. D., & Woodson, B. T. (2010). The Sleep Study: Studying Life Effects and Effectiveness of Palatopharyngoplasty.
Though, uvulopalatopharyngoplasty UPPP improves the physical health of patients, the procedure does not necessarily cure the condition. Thus, Weaver and Woodson (2010) sought to evaluate whether the technique improved sleeping patterns based on a questionnaire. Follow up was conducted after 3 and 6 months amongst some of the 68 patients. Since there was an improvement in sleep related measures, the technique is an effective community based intervention that can improve quality of life in patients with sleep apnea.
Article 5: Weaver, E. M. (2009). Survival of Veterans with Apnea: Continuous Positive Airway Pressure versus Surgery.
The study compared the effectiveness of continuous positive airway pressure (CPAP) versus uvulopalatopharyngoplasty (UPPP) among patients in veteran facilities. The study compared results of patients with sleep apnea and using the two methods to manage the condition, and integrated demographics data on gender, race, age and period under treatment. Of the patients 7.1 % of CPAP died while only 3.4% of UPPP succumbed to death in the same period, and further analysis also showed that CPAP patients were at a higher risk of death. Consequently surgical methods are more effective than CPAP putting into considerations all the demographics. In patient care, it is necessary to use CPAP over time before surgery is conducted. Nonetheless, the study studied more CPAP patients than UPPP, and hence there is need for more robust studies to compare results in using the two techniques.
Article 6: Caples, S. M., Rowley, J. A., Prinsell, J. R., Pallanch, J. F., Elamin, M., Katz, S. G., & Harwick, J. D. (2010). Surgical Modifications of the Upper Airway for Obstructive Sleep Apnea in Adults: A Systematic Review and Meta-Analysis. SLEEP; 33(10): 1396-1407.
Though positive airway pressure (PAP) is the first option for people with OSA, many seek alternative techniques including surgeries. Caples et al (2010) used meta- analysis and systematic review of literature for patients who sought upper airway surgeries. All the researches reviewed included in the study had to show data results of the study for consideration. The authors conclude that after sung the apnea -hypopnea index it was plausible that upper airway surgery is effective. Among the researches reviewed included those with small samples. There is need for studies to understand the effect of various surgical procedures adopted and how they can be integrated in nursing.
Article 7: Woodson, T. B. (2009). A Randomized Trial Temperature-Controlled Radiofrequency, Continuous Positive Airway Pressure, and Placebo for Obstructive Sleep Apnea Syndrome. Otolaryngology; 128(6): 848-861.
The study sought to identify the better of the two interventions between multilevel temperatures controlled radiofrequency (TCRFA) and the continuous positive airway pressure (Woodson, 2009). Through randomization, the author used a placebo group to compared results for both CPAP and TCFRA. Both CPAP and TCFRA had no major difference as there was improvement in sleeping and apnea index, but the placebo group showed no improvement. Thus nurses should consider using TCRFTA to improve patient’s airways. The major weakness of the study is that it did not look into which of the two methods was more effective.
Article 8: Steward, D. L. (2009). Multilevel Temperature-controlled Radiofrequency ablation (TCRFTA) for Obstructive Sleep Apnea: Extended Follow-up. Otolaryngology; 132 (4): 630-635.
Steward (2009) sought to investigate effectiveness of using radio frequency for patients suffering from obstructive sleep apnea. The patients chosen had mild and moderate case of OSA and required one year to complete the temperature controlled radiofrequency tissue ablation (TCRFTA). There was an improvement in sleeping patterns for the patients after the treatment showing that TCRFTA was effective in maintaining daytime somnolence. The main strength is that the researcher followed up the patients for approximately 2 years and hence the study was comprehensive. The article shows that patient care should integrate radiofrequency in managing OSA cases.
Article 9: Riley, R. (2009). An Adjunctive of Radiofrequency Volumetric Reduction of the Tongue for OSAS. Otalaryngology; 129(1):37-42.
The study was based on a non randomized study of 20 patients who all had tongue base obstruction. Using the temperature controlled radiofrequency volumetric tissue reduction, the patients were less sleepy and the apnea hypopnea index reduced. Though, there were reported cases of pain after the intervention there were no severe complications after the procedure. The study shows that nurses should consider using both TCRF together with dorsal based intervention techniques as the success rates are higher.
Article 10: Ephros, H. D., Madani, M., & Yalamanchili, S. C. (2010). Surgical Treatment of Snoring & Ob...