Ayako Inoshita

We hypothesized that patients with head and neck cancer (HNC) have impaired pharynglaryngeal function during sleep compared with individuals without HNC, making them more susceptible to aspiration. We assumed polysomnography (PSG) would reveal decreased swallowing frequency, prolonged swallowing duration, reduced submental electromyographic (EMG) amplitude during swallowing, and abnormal timing of swallowing relative to respiratory phases. Patients with HNC who underwent radiotherapy to the pharyngolaryngeal region were enrolled. Age-, sex-, and body mass index-matched individuals without HNC served as controls. Swallowing frequency, duration, submental EMG amplitude during swallowing, and respiratory phases before and after swallowing were assessed using PSG and compared between groups. Data normality was assessed using the Shapiro–Wilk test, appropriate parametric or nonparametric analyses were applied with statistical significance set at p < 0.05. Fifteen male patients with HNC and matched controls were analyzed. Swallowing frequency during sleep was significantly higher in the HNC group overall (p = 0.016), during rapid eye movement (REM) sleep (p = 0.033), and during non-REM sleep (p = 0.015). Swallowing duration during wakefulness was longer in the HNC group (p = 0.015), while no significant difference was observed during sleep (p = 0.73). Submental EMG amplitude during swallowing significantly decreased during sleep in the HNC group (p = 0.025). Respiratory pauses before and after swallowing were more frequent in the HNC group (p = 0.002 and p = 0.013, respectively). Swallowing function during sleep may be impaired in patients with HNC. Because the pharyngolaryngeal muscles are common to both swallowing and airway patency, dysfunction in this region may contribute to OSA-related breathing disturbances. Early identification and management of OSA, combined with targeted swallowing rehabilitation, may help reduce the risk of aspiration, improve airway safety, and potentially lower the risk of life-threatening complications, including sudden death.

Purpose: Continuous positive airway pressure (CPAP) therapy remains the cornerstone of obstructive sleep apnea (OSA) treatment, considerably reducing the risk of cardiovascular complications and improving patient outcomes. However, adherence to CPAP therapy is a major challenge and poor compliance limits its efficacy. This study investigated the potential of aromatherapy, a noninvasive, cost-effective intervention, to improve CPAP adherence and enhance sleep quality in patients with OSA. Methods: A prospective observational pilot study was conducted in patients with obstructive sleep apnea who demonstrated poor CPAP adherence (< 70% usage and < 4 h/night). Participants were exposed to lavender or cypress aroma oil during sleep. Pre- and post-intervention subjective sleep measures Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS), and objective CPAP usage metrics were collected. Normally distributed variables were analyzed using paired t-tests, and non-normally distributed variables were analyzed using the Wilcoxon signed-rank test. Statistical significance was set at p < 0.05. A post hoc power analysis was performed based on observed effect sizes for the primary outcomes. Results: Eight patients with OSA (mean age 53.5 years; 4 males, 4 females) participated in the study. Following 67 days of treatment, the median PSQI score significantly improved from 9.0 to 6.5 ( p = 0.006), and the median ESS score decreased from 9.0 to 6.5 ( p = 0.034). Additionally, CPAP for more than 4 h increased from 5.0% to 25.7% ( p = 0.028). The median usage duration improved from 149 to 231 min ( p = 0.018). No significant change in apnea hypopnea index (AHI) was observed during CPAP use, decreasing from 3.2 events/h to 1.3 events/h ( p = 0.226), which is consistent with the understanding that appropriately applied CPAP maintains effective control of respiratory events. Conclusion: Aromatic stimulation with essential oils shows promise in improving both CPAP adherence and sleep quality, offering a novel approach to enhance OSA treatment efficacy.

Original Article Lifestyle change during the COVID-19 pandemic in Japan: implications for continuous positive airway pressure adherence in obstructive sleep apnea patient Yo Suzuki, Ayako Inoshita, Naoko Sata, Erina Ishimizu, Shoko Suda, Ryo Naito, Takatoshi Kasai, Fumihiko Matsumoto

Accidentally extruded root canal filler within the sinuses may induce maxillary sinusitis with fungal mass. The authors describe 2 cases of gutta-percha-induced fungal masses in the left maxillary sinus of 2 women. The lesions were evaluated preoperatively using both computed tomography and magnetic resonance imaging, providing comprehensive insights into the condition. In one patient, the lesion was located such that it could be resected through the middle meatal antrostomy alone. However, the second patient presented with an anteroinferiorly situated lesion that necessitated not only a transnasal approach but also an endoscopic modified medial maxillectomy. Both patients recovered uneventfully after surgery. This case series is the first published report of 2 cases of gutta-percha-induced maxillary sinus fungal masses, with their imaging findings, successfully treated through different routes through transnasal endoscopic surgery. These reports highlight the need for a collaborative approach between dental practitioners and otolaryngologists. In addition to the patient’s wishes, surgical interventions must consider the unique characteristics of each case and the potential for collaboration across different medical specialties.

Lobular capillary hemangiomas (LCH), which usually originate in the skin and mucous membranes of the oral cavity, are uncommon from the posterior portion of the inferior turbinate. Although the exact cause of LCH in the nasal cavity has not been elucidated, trauma, caused by factors such as intranasal packing and habitual nose-picking, has been reported as one of the causes. In addition, 2 cases of LCH caused by submucosal resection with powered instrumentation to the inferior turbinate have been reported, suggesting that various types of traumas to the nasal mucosa can cause LCH. The authors report the first case of LCH formation in the posterior portion of the inferior turbinate after cauterization with silver nitrate.

Purpose Allergic rhinitis (AR) is associated with obstructive sleep apnea (OSA) and nasal obstruction causes decreased adherence to continuous positive airway pressure (CPAP). The purpose is to evaluate the effects of antiallergic agents on CPAP adherence and sleep quality. Methods A longitudinal study was made of patients who use CPAP for OSA and treated with antiallergy agents for spring pollinosis. We compared the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), nasal symptoms scores (NSS), and data from CPAP before and after treatment. Then, we classified the subjects into two groups based on the baseline PSQI score: one group without a decreased sleep quality (PSQI < 6) and the other group with decreased sleep quality (PSQI ≥ 6). Results Of 28 subjects enrolled, 13 had good sleep quality and 15 had poor sleep quality. PSQI showed significant improvements after medication (p = 0.046). ESS showed no significant differences after AR medication (p = 0.565). Significant improvement was observed after the prescription of antiallergy agents in all items of NSS (sneezing, p < 0.05; rhinorrhea, p < 0.01; nasal obstruction, p < 0.01; QOL, p < 0.01). The percentage of days with CPAP use more than 4 h increased significantly after the administration of rhinitis medication (p = 0.022). In the intragroup comparisons of PSQI ≥ 6 group, PSQI decreased significantly (p < 0.05). For the NSS in intragroup comparisons of PSQI ≥ 6 group, all parameters showed significant improvement (sneezing, p = 0.016; rhinorrhea, p = 0.005; nasal obstruction, p < 0.005; QOL, p < 0.005). Conclusion The use of antiallergy agents can improve CPAP adherence and sleep quality in patients with OSA on CPAP.