Ahmed Yassin Bahgat

Background/Objectives: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a type 2 inflammatory condition that significantly impairs health-related quality of life (HRQoL), particularly sleep quality. Beyond mechanical nasal obstruction, type 2 cytokines (IL-4, IL-13) are thought to directly disrupt sleep architecture. Dupilumab, an IL-4Rα antagonist, is approved for severe CRSwNP, but its specific effect on sleep quality remains under investigation. This systematic review aims to evaluate the impact of dupilumab on sleep quality in patients with severe, uncontrolled CRSwNP. Methods: A comprehensive literature search was conducted in PubMed/MEDLINE, Google Scholar, and Web of Science up to June 2026. We included adult studies (≥1 month of dupilumab 300 mg every 15 days) reporting sleep outcomes using validated tools (Epworth Sleepiness Scale [ESS], Pittsburgh Sleep Quality Index [PSQI], Insomnia Severity Index [ISI], or the SNOT-22 sleep domain). Risk of bias was assessed using ROBINS-I and RoB 2 tools. Results: Seven studies (n = 2164 patients) met inclusion criteria. Across observational and post hoc RCT analyses, dupilumab consistently improved the SNOT-22 sleep domain (mean reduction up to −7.02 points at 24 weeks; p < 0.001), PSQI, ESS, and ISI scores. One study reported a decrease in poor global sleep quality from 88.9% at baseline to 5.7% at 12 months. However, most observational studies had a serious risk of bias due to unaddressed confounding and lack of blinding. No polysomnographic data were reported. Conclusions: Dupilumab was associated with significant improvements in patient-reported sleep quality in CRSwNP patients across seven included studies. However, the evidence is limited by the absence of objective sleep measures, the serious risk of bias in most observational studies, and the lack of comparative head-to-head data. High-quality randomized controlled trials with prespecified sleep endpoints and polysomnographic assessments are needed before definitive conclusions can be drawn.

Objective: This work is a feasibility study of using barbed sutures for managing obstructive sleep apnea (OSA) patients with mainly retropalatal collapse in our institution. Study design: Retrospective cohort study. Setting: Tertiary university hospital. Methods: Twenty patients with OSA were enrolled. All cases were evaluated preoperatively using the Epworth Sleepiness Scale (ESS), polysomnography (PSG), and sleep endoscopy. Barbed Reposition Pharyngoplasty (BRP) was performed for all patients by a single surgeon. The technique was evaluated regarding operative time, postoperative symptom relief, and complications. Surgical success was defined as a reduction in the AHI by 50% and AHI < 20 after surgery. Results: The study included 15 males and five females, with a mean age of 45 ± 10 years. The mean operative time was 19.25 ± 3.73 min. The mean postoperative ESS was 7.75, significantly better than the pre-operative ESS: 12.3 ( P = 0.001). The mean AHI post-operatively was significantly lower than the pre-operative measure (11.30 ± 6.31 compared to 30.05 ± 20.18 ( Z = 3.921, P value < 0.001)). The surgical success was estimated to be 70%. Postoperative partial suture extrusion occurred in 3 patients (15%) with no symptoms. Conclusion: BRP is an easy, safe, and effective surgical technique for managing retropalatal collapse in patients with snoring and/or OSA.

Background: Obstructive sleep apnea syndrome (OSAS), affecting approximately 1 billion adults globally, is characterized by recurrent airway obstruction during sleep, leading to oxygen desaturation, elevated carbon dioxide levels, and disrupted sleep architecture. OSAS significantly impacts quality of life and is associated with increased morbidity and mortality, particularly in the cardiovascular and cognitive domains. The cyclic pattern of intermittent hypoxia in OSAS triggers oxidative stress, contributing to cellular damage. This review explores the intricate relationship between OSAS and oxidative stress, shedding light on molecular mechanisms and potential therapeutic interventions. Methods: A comprehensive review spanning from 2000 to 2023 was conducted using the PubMed, Cochrane, and EMBASE databases. Inclusion criteria encompassed English articles focusing on adults or animals and reporting values for oxidative stress and inflammation biomarkers. Results: The review delineates the imbalance between pro-inflammatory and anti-inflammatory factors in OSAS, leading to heightened oxidative stress. Reactive oxygen species biomarkers, nitric oxide, inflammatory cytokines, endothelial dysfunction, and antioxidant defense mechanisms are explored in the context of OSAS. OSAS-related complications include cardiovascular disorders, neurological impairments, metabolic dysfunction, and a potential link to cancer. This review emphasizes the potential of antioxidant therapy as a complementary treatment strategy. Conclusions: Understanding the molecular intricacies of oxidative stress in OSAS is crucial for developing targeted therapeutic interventions. The comprehensive analysis of biomarkers provides insights into the complex interplay between OSAS and systemic complications, offering avenues for future research and therapeutic advancements in this multifaceted sleep disorder.

Objectives: To investigate through an international survey the actual clinical application of drug-induced sleep endoscopy (DISE) in pediatric patients with obstructive sleep apnea (OSA) and to clarify the use, application, clinical indications, and protocol of pediatric DISE. Methods: A specific survey about pediatric DISE was initially developed by five international otolaryngologists with expertise in pediatric sleep apnea and drug-induced sleep endoscopy and was later spread to experts in the field of sleep apnea, members of different OSA-related associations. Results: A total of 101 participants who answered all the survey questions were considered in the study. Sixty-four sleep apnea experts, equivalent to 63.4% of interviewed experts, declared they would perform DISE in pediatric OSA patients. A total of 81.9% of responders agreed to consider the DISE as the first diagnostic step in children with persistent OSA after adenotonsillectomy surgery, whereas 55.4% disagreed with performing DISE at the same time of scheduled adenotonsillectomy surgery to identify other possible sites of collapse. In the case of young patients with residual OSA and only pharyngeal collapse during DISE, 51.8% of experts agreed with performing a velopharyngeal surgery. In this case, 27.7% disagreed and 21.4% were neutral. Conclusion: Pediatric DISE is internationally considered to be a safe and effective procedure for identifying sites of obstruction and collapse after adenotonsillectomy in children with residual OSA. This is also useful in cases of patients with craniofacial malformations, small tonsils, laryngomalacia or Down syndrome to identify the actual site(s) of collapse. Despite this evidence, our survey highlighted that pediatric DISE is not used in different sleep centers.

Background: In a majority of OSA children with adenotonsillar hypertrophy, very mild symptoms or no symptoms at all are related to the cardiopulmonary system, but symptomless chronic changes may slowly occur in these children. Therefore, it is wise to monitor these patients by an easy, noninvasive cost-effective method; this can easily be done by monitoring mean pulmonary artery pressure (mPAP) of these children with Doppler echocardiography. Doppler echocardiography has been demonstrated to have a perfect correlation with cardiac catheterization. This study aims to determine the pulmonary arterial systolic pressure (PASP) in OSA children with hypertrophied tonsils and adenoid and to clarify whether adenotonsillectomy has any effect on pulmonary arterial pressure of these children. Methods: Study was conducted on 50 children of both sexes aged from 4 to 15 years. Children complain of loud snoring and obstructive sleep apnea due to hypertrophied tonsils and adenoids. Children fit for general anesthesia and adenotonsillectomy. In all subjects, Doppler echocardiography was done before and after adenotonsillectomy. Results: Comparison between preoperative PASP and after 2 months showed that normal PASP were found in 25 (50.0%) and 50 (100.0%) for preoperative and after 2 months respectively. There was statistically significant difference between preoperative PASP and after 2 months. However, there was no correlation between preoperative PASP and age, sex, or duration of symptoms. Conclusion: From this study, we conclude that adenotonsillar hypertrophy causes higher PASP in OSA children, PASP is worse in neglected OSA cases with long duration of symptoms, and adenotonsillectomy is an effective therapeutic measure in such patients.

PURPOSE: The aim of our retrospective study is evaluating the effectiveness of barbed repositioning pharyngoplasty (BRP) in a consecutive cohort of patients and assessing its impact on positional indexes in order to potentially identify specific obstructive sleep apnea (OSA) phenotypes for patients who might benefit more significantly from this intervention. METHODS: A single-center retrospective study with baseline and follow-up type III sleep tests evaluating the Apnea Hypopnea Index (AHI), supine AHI, non-supine AHI, oxygen desaturation index (ODI), mean SaO2, percentage of time spent at SaO2 below 90% (CT90), and lowest oxygen saturation (LOS) were performed. The patients were then divided into groups according to Sher’s criteria and Amsterdam Positional OSA Classification (APOC). Parametric and non-parametric tests and univariate and multivariate analyses were conducted. RESULTS: The study finally included 47 patients. The statistical analysis showed significant improvement in AHI, supine AHI, non-supine AHI, and ODI after surgery. The linear regression showed that high values of baseline AHI, AHI supine, and AHI non supine predict more significant postoperative reductions in AHI, AHI supine, and AHI non supine, respectively. Therapeutic success was achieved in 22 patients out of 47. The logistic regression did not find any independent risk factors for success. The most significant reduction in AHI, supine AHI, and non-supine AHI was observed in the APOC 3 group while the APOC 1 patients experience a substantially lower improvement. CONCLUSIONS: BRP appears to be an effective surgical procedure for the treatment of OSA. The non-positional patients might benefit more from BRP in comparison with positional patients. Moreover, OSA severity should not be considered an absolute contra-indication for this surgical procedure.

Purpose: Evaluate the effectiveness of the head-of-bed elevation position (HOBE) with a 30° elevation of the head and trunk, in improving obstruction of the upper airways in obstructive sleep apnea (OSA) patients. A prospective trial simultaneously performing drug-induced sleep endoscopy (DISE) and polysomnography (PSG) tests was performed. Methods: Forty-five patients were included in the prospective study protocol. All patients enrolled in the study and underwent the following evaluations: (1) a drug-induced sleep endoscopy, with an evaluation of obstructions and collapse of the upper airways at 0° and in a HOBE position, with head and trunk elevation of 30°; (2) an overnight PSG assessment in the hospital with head and trunk elevation from 0° to 30° during the night; (3) a questionnaire to evaluate the feedback of patients to sleeping with head-of-bed elevation. Results: Velum (V) and oropharynx lateral wall (O) collapses were reduced in the 30° up position. There were no statistical differences that emerged in the obstruction of the tongue base and epiglottis between the 0° position and the 30° up position (p > 0.05). The average AHI score changed from 23.8 ± 13.3 (0° supine position) to 17.7 ± 12.4 (HOBE position), with a statistical difference (p = 0.03); the same statistical difference emerged in the percentage of apneas that decreased from 55 ± 28.1 to 44 ± 25.8 (p = 0.05). Conclusions: By adopting the HOBE position with 30° elevation of the head and trunk, it is possible to obtain a reduction of upper airways collapses and an improvement of apnea/hypopnea events and nightly respiratory outcomes.

Background: When the nasal obstruction is identified in cases of snoring and/or OSA with suspected oropharyngeal and nasal obstruction, the combination of nasal and palate surgeries is suggested to be conducted in either a single-staged or multi-staged manner. This study aimed to assess the efficacy and safety of combined nasal-palatopharyngeal surgery in a staged versus a single-stage multilevel procedure. Methods: Prospective randomized comparative study included 60 patients with combined nasal and retropalatal obstruction, > 18 years old, BMI < 40, with snoring and/or mild to moderate OSA (AHI ˂ 30) and ASA < 3. Patients were randomly allocated into three groups (every 20 patients); groups 1 and 2 patients underwent a staged procedure, where group 1 had a nasal surgery as a first step for management of nasal obstruction, followed by a BRP after 3 months and vice versa for group 2 patients, while group 3 patients had a single-stage combined nasal surgery and (BRP). Preoperative and 6 months post-operative SOS, SBPS, ESS scores, and polysomnography data (AHI, ODI) were recorded. Post-operative complications, pain (VAS), and duration of hospital stay were monitored. Results: Post-operative improvement in SOS, SBPS, EES, AHI, and ODI were similar after a staged or a single-stage multilevel procedure with no significant intergroup differences. Total operative time for single-stage multilevel surgery (80 ± 25 min) was significantly shorter than that for the staged procedure (135 ± 30 min). Post-operative complications were temporary and not severe in both surgical procedures and included wound infection (11.67%) and nasal bleeding (11.67%), which were resolved immediately by firm pressure and nasal packing and suture extrusion (5%). However, it didn't appear to alter anatomical and functional outcomes. Post-operative pain by VAS was significantly higher after a single-stage multilevel procedure (5.8 ± 1.4) compared to (2.8 ± 0.6 and 3.7 ± 0.7, respectively) in groups 1 and 2 that underwent a staged surgery. Conclusion: Combined nasal surgery and BRP, either staged or single-stage multilevel procedure in the treatment of snoring and/or mild and moderate OSA with nasal obstruction, provide similar successful improvement in subjective and objective findings. A single-stage procedure was safer because of a significantly shorter total operative time, and repeated hospitalization and need for anesthesia were avoided.

Amyloidosis is to be considered in the differential diagnosis of postoperative edema of tongue base after its ablation. It might be triggered by surgical trauma. After establishment of diagnosis, cause of secondary amyloidosis should be excluded.

Objective: Plasma is formed by creating a high‐density energy field within an electrically conductive fluid such as saline. Sometimes ablated bits of tissue get stuck between the electrodes of the wand, obstructing the suction channel. The purpose of this study is to investigate the effect of cooling the irrigating saline during ablation of the hypertrophied tongue base in patients with obstructive sleep apnea.Study Design: Prospective randomized controlled trial.Setting: An otorhinolaryngology department in Main University hospitals.Methods: Sixty adult patients with obstructive sleep apnea and tongue base hypertrophy underwent tongue base ablation surgery. Patients were randomly divided into 2 groups of 30 patients each: cooled saline and room temperature saline. The Coblation wand used was the EVac 70 Xtra HP (Smith & Nephew).Results: In this study, a significant difference in operative time (mean ± SD) was seen between groups: 21.2 ± 5.5 minutes in the cold group and 47 ± 9.5 minutes in the control group (P =. 001). The wands in the cold group did not obstruct, while all the wands in the control group were obstructed by tissue clogs with variable degrees, hence wasting more time to clean the wands’ tips.Conclusion: Cooling the irrigating saline overcame the problem of wand clogs, and the wand tip did not occlude at all during the procedures, thus saving time lost in wand cleaning and demonstrating a faster and safer surgical procedure. Further studies are needed to identify the hemostatic effect of the cooled saline over the regular one.