AAO-HNSF 2012: The Frontier of Sleep Breathing Disorders

He said he’s made it the aim of his research to develop ways of treating OSA with something other than a CPAP machine. “I don’t think CPAP is the be-all-end-all,” he said. “I spend most of my time in clinic helping patients who are intolerant to CPAP.”

The Role of Genetics

Leila Kheirandish-Gozal, MD, director of clinical sleep research in the department of pediatrics at the University of Chicago Pritzker School of Medicine, said the emergence of two new therapies for children with OSA is encouraging.

A different approach is required for OSA in children, because it is associated with increased inflammation in the upper airway as well as systemic inflammation and has its peak incidence between ages 2 and 8. It can also have long-lasting neurobehavioral, cardiovascular, metabolic and somatic growth consequences, Dr. Kheirandish-Gozal said.

Nasal budesonide, a glucocorticoid steroid, and oral montelukast, an anti-inflammatory drug, have been shown to be effective individually in treating OSA. Together, they’ve been shown to be effective as well, especially after adenotonsillar surgery when residual sleep apnea is identified, with improvements in apnea hypopnea index, oxygen levels, and the number of arousals from sleep, compared with controls (Pediatrics. 2006;117(1):e61-e66).

Work is now turning to genetics. Dr. Kheirandish-Gozal said her lab screened about 30,000 genes that are involved in the enlargement of tonsils and, from those, found 49 candidate genes that they think might play a role in pediatric OSA. “In the past few years we have been, one by one, testing every one of them,” she said. “Maybe in the near future—it may sound like science fiction—but maybe we can come up with a novel treatment or drug component that can be topically applied on the adenoids or tonsils,”—not in the severe cases, she added, but in the cases in which surgery isn’t necessarily an option.

Surgery is truly successful, meaning complete resolution of OSA, in only about 27 percent of cases, she said, even though improvements will occur in the vast majority. “In some cases surgery is not needed,” she said.

Computer Modeling for Airflow

In another presentation, Nelson Powell, MD, DDS, adjunct clinical professor of sleep disorders medicine and research at Stanford Medical Center in Palo Alto, Calif., showed how researchers have developed a way to “see” the flow of air through the pharynx using three-dimensional CT imaging and computational fluid dynamics, in which a computer is applied to math models created to track phenomena with fluid qualities.