This study investigated the effect of speaking rate on aerodynamic and acoustic measures of velopharyngeal (VP) function in 27 adult speakers (14 M, 13 F). The pressure-flow method (Warren & Dubois, 1964) was used to collect aerodynamic data of /m/ and /p/ segments in the word “hamper” and the utterances “Mama made some lemon jam” (MMJ) and “Buy Bobby a puppy” (BBP). A Nasometer was used to collect nasalance scores and nasalance distance for MMJ and BBP. Measures were collected under 4 speaking rate conditions (normal, fast, slow, and slowest). Results indicated that nasal airflow and VP orifice area were unaffected by speaking rate whereas intraoral pressure decreased as speaking rate slowed. Nasalance was greater for BBP at slow speaking rates and nasalance distance (MMJ – BBP) decreased at slow rates. The data was interpreted with respect to expectations set forward in the literature on normal and disordered speech motor control.

This study investigated the effect of speaking rate on aerodynamic and acoustic measures of velopharyngeal (VP) function in 27 adult speakers (14 M, 13 F). The pressure-flow method (Warren & Dubois, 1964) was used to collect aerodynamic data of /m/ and /p/ segments in the word “hamper” and the utterances “Mama made some lemon jam” (MMJ) and “Buy Bobby a puppy” (BBP). A Nasometer was used to collect nasalance scores and nasalance distance for MMJ and BBP. Measures were collected under 4 speaking rate conditions (normal, fast, slow, and slowest). Results indicated that nasal airflow and VP orifice area were unaffected by speaking rate whereas intraoral pressure decreased as speaking rate slowed. Nasalance was greater for BBP at slow speaking rates and nasalance distance (MMJ – BBP) decreased at slow rates. The data was interpreted with respect to expectations set forward in the literature on normal and disordered speech motor control.

In der Veterinärmedizin existieren nur wenige Veröffentlichungen zur, in der Humanmedizin weitgehend etablierten, Sonographie des Oropharynx. Da vor allem bei brachyzephalen Hunden das Ausmaß der Hyperplasie der oropharyngalen Weichteile, insbesondere des weichen Gaumens, von großem diagnostischen Interesse ist, wird nach Möglichkeiten zur wenig invasiven Untersuchung dieser Region am wachen Patienten gesucht. So war es Ziel dieser kumulativen Dissertation die Grundlagen der sonographischen Untersuchungs- und Messmethode am weichen Gaumen zu erarbeiten. Die Darstellung der sonographischen Anatomie des weichen Gaumens und der Umgebung erfolgte in der ersten Studie an sieben Tierkörpern normozephaler Hunderassen. Die transkutane Untersuchung erfolgte bei submentaler Schallkopfauflage. Zudem kamen speziell geformte Schallköpfe zur direkten Auflage auf den weichen Gaumen in einer intraoralen Untersuchung zum Einsatz. Zur Erleichterung der Identifizierung der anatomischen Strukturen wurden Wasserbad- und sequentielle Ultraschalluntersuchungen im Anschluss an submentale Weichteilpräparationen des Maulhöhlenbodens durchgeführt. Unter Herstellung des Gewebekontaktes zwischen Zunge und weichem Gaumens bei submentaler Schallkopfauflage, gelang die transkutane sonographische Darstellung des weichen Gaumens im kranialen und mittleren Bereich. Der weiche Gaumen wies eine mondsichelähnliche Form und eine geringe Echogenität auf. Als charakteristisch zeigte sich der Übergang von hartem zu weichem Gaumen, die Darstellung des kaudalen Anteils des Gaumensegels ist aufgrund der umgebenen Luft und Überlagerung mit dem Zungenbein nur eingeschränkt möglich. Die intraorale Untersuchung erlaubte die Darstellung der gaumenspezifischen Echotextur. In der zweiten Studie wurde an 15 normozephalen Hunden in Allgemeinanästhesie die Dicke der Gaumensegel sowohl sonographisch als auch computertomographisch an zwei definierten Messpunkten bestimmt. Die Übereinstimmung der Ergebnisse von wiederholten Messungen mit der jeweiligen Messmethode wurde geprüft. Die wiederholten Messungen erzielten sehr gute Übereinstimmungen (Mean absolute deviation von 0), so dass davon ausgegangen werden kann, dass sowohl die Sonographie als auch die CT reproduzierbare Messungen ermöglicht. Im Messmethodenvergleich wurden die Messergebnisse, die mit den unterschiedlichen Messverfahren (Ultraschall und CT) gewonnen wurden, in der Bland-Altman Auswertung miteinander verglichen. Es waren Abweichungen für beide Messpunkte zu verzeichnen, wobei der Mittelwert der Abweichung vor allem für den zweiten Messpunkt mit 0,31 cm als hoch anzusehen ist. Der Mittelwert der Abweichung fällt am ersten Messpunkt mit 0,08 cm geringer aus. Die klinisch relevanten Abweichungen wurden als Folge der zwischen beiden Messmethoden variierenden Untersuchungsbedingungen, insbesondere der abweichenden Patientenlagerung, interpretiert. Sonographie und CT sind damit, trotz guter Reliabilität des einzelnen Verfahrens, als nicht austauschbare Methoden zur Gaumensegeldickenmessung anzusehen. Die transkutane Sonographie ermöglichte, unter den geschilderten Untersuchungs-bedingungen, erstmals eine Darstellung des kranialen und mittleren Anteils des weichen Gaumens. Der kaudale Anteil des Gaumensegels konnte nicht identifiziert werden. Die Sonographie birgt, nach Ermittlung entsprechender Referenzbereiche, das Potential einer nichtinvasiven, schnellen Untersuchungsmethode zur Vermessung der Gaumensegeldicke am wachen Hund.

Os objetivos do presente estudo foram: 1) mensurar e descrever as medidas de extensão e espessura do véu palatino e da profundidade da nasofaringe em indivíduos com fissura transforame unilateral operada (FTU) que apresentavam disfunção velofaríngea (DVF); 2) calcular e descrever a razão entre a profundidade da nasofaringe e a extensão do véu palatino; 3) comparar as medidas encontradas para os indivíduos deste estudo com as normas descritas por SUBTELNY (1957); 4) comparar as medidas encontradas entre os sexos masculino e feminino; 5) comparar as medidas encontradas para os indivíduos que receberam palatoplastia com procedimento de Furlow (FW) com as medidas daqueles que receberam procedimento de Von Langenbeck (VL); 6) correlacionar as medidas encontradas com as idades dos indivíduos. A casuística foi constituída de 30 indivíduos com FTU e DVF, sendo 15 meninas e 15 meninos, com média de idade de 6 anos e 11 meses. Desses 30, 10 tiveram o palato operado pela técnica de FW e 20 pela de VL, entre as idades de 9 e 18 meses. Para definição da conduta para correção da DVF, todos os indivíduos foram submetidos ao exame de videofluoroscopia. Uma imagem em tomada lateral do MVF em repouso fisiológico foi selecionada e editada em um DVD para análise e mensuração das estruturas velofaríngeas de interesse. Três fonoaudiólogas experientes em videofluoroscopia realizaram as mensurações. Os resultados indicaram média de 27,4 mm para as medidas de extensão do véu palatino, de 9,7 mm para as de espessura do véu palatino, de 22,7 mm para as de profundidade da nasofaringe e de 0,86 para a razão entre a profundidade da nasofaringe e a extensão do véu palatino. Comparando os resultados do presente estudo com os de Subtelny (1957) diferença significante foi encontrada para as medidas da espessura do véu palatino, da profundidade da nasofaringe e da razão entre a profundidade da nasofaringe e a extensão do véu palatino. Os resultados também demonstraram diferença significante entre a média das medidas de extensão do véu palatino nos sexos masculino e feminino. Não houve diferença significante entre a média das medidas das estruturas avaliadas para os indivíduos operados pela técnica de FW nem pelos operados pela VL. Não houve correlação significante entre a variável idade e as medidas obtidas. / The objectives of the present study were: 1) to measure and to describe length and thickness of the velum and depth of nasopharynx for individuals with unilateral operated cleft lip and palate (UCLP) with velopharyngeal dysfunction (VPD); 2) to calculate and describe the depth of nasopharynx to velar length ratio (D/L); 3) to compare measures found for the individuals in this study with the norms described by Subtelny (1957) for normal individuals; 4) to compare the measures between males and females; 5) to compare the measures between individuals who received palatoplasty with the Furlow (FW) procedure to those who received the Von Langenbeck (VL) procedure; 6) correlate measures between different ages. The sample included 30 individuals with UCLP and VPD, 15 girls and 15 boys, with mean age of 6y11m. Ten individuals had palatoplasty with FW procedure and 20 with VL, between the ages of 9 and 18 months. For identifying best procedure for correcting VPD all individuals were submitted to videofluoroscopy assessment. A lateral view of the velopharyngeal mechanism during rest was selected and edited into a DVD, for analysis and measurement of the velopharyngeal structures of interest. Three speech-language pathologists experienced in videofluoroscopic assessment obtained all measures studied. The results revealed a mean velar length of 27.4 mm; mean velar thickness of 9.7 mm; mean depth of nasopharynx of 22.7 mm; D/L of 0.86. Comparing these results to Subtelny\'s (1957) a significant difference was found for measures of velar thickness, depth of nasopharynx velar length and D/L. Significant difference was found between males and females only for velar length. No significant differences were found between different techniques for palatoplasty. There was no significant correlation between age and the measurements obtained.

Os objetivos do presente estudo foram: 1) mensurar e descrever as medidas de extensão e espessura do véu palatino e da profundidade da nasofaringe em indivíduos com fissura transforame unilateral operada (FTU) que apresentavam disfunção velofaríngea (DVF); 2) calcular e descrever a razão entre a profundidade da nasofaringe e a extensão do véu palatino; 3) comparar as medidas encontradas para os indivíduos deste estudo com as normas descritas por SUBTELNY (1957); 4) comparar as medidas encontradas entre os sexos masculino e feminino; 5) comparar as medidas encontradas para os indivíduos que receberam palatoplastia com procedimento de Furlow (FW) com as medidas daqueles que receberam procedimento de Von Langenbeck (VL); 6) correlacionar as medidas encontradas com as idades dos indivíduos. A casuística foi constituída de 30 indivíduos com FTU e DVF, sendo 15 meninas e 15 meninos, com média de idade de 6 anos e 11 meses. Desses 30, 10 tiveram o palato operado pela técnica de FW e 20 pela de VL, entre as idades de 9 e 18 meses. Para definição da conduta para correção da DVF, todos os indivíduos foram submetidos ao exame de videofluoroscopia. Uma imagem em tomada lateral do MVF em repouso fisiológico foi selecionada e editada em um DVD para análise e mensuração das estruturas velofaríngeas de interesse. Três fonoaudiólogas experientes em videofluoroscopia realizaram as mensurações. Os resultados indicaram média de 27,4 mm para as medidas de extensão do véu palatino, de 9,7 mm para as de espessura do véu palatino, de 22,7 mm para as de profundidade da nasofaringe e de 0,86 para a razão entre a profundidade da nasofaringe e a extensão do véu palatino. Comparando os resultados do presente estudo com os de Subtelny (1957) diferença significante foi encontrada para as medidas da espessura do véu palatino, da profundidade da nasofaringe e da razão entre a profundidade da nasofaringe e a extensão do véu palatino. Os resultados também demonstraram diferença significante entre a média das medidas de extensão do véu palatino nos sexos masculino e feminino. Não houve diferença significante entre a média das medidas das estruturas avaliadas para os indivíduos operados pela técnica de FW nem pelos operados pela VL. Não houve correlação significante entre a variável idade e as medidas obtidas. / The objectives of the present study were: 1) to measure and to describe length and thickness of the velum and depth of nasopharynx for individuals with unilateral operated cleft lip and palate (UCLP) with velopharyngeal dysfunction (VPD); 2) to calculate and describe the depth of nasopharynx to velar length ratio (D/L); 3) to compare measures found for the individuals in this study with the norms described by Subtelny (1957) for normal individuals; 4) to compare the measures between males and females; 5) to compare the measures between individuals who received palatoplasty with the Furlow (FW) procedure to those who received the Von Langenbeck (VL) procedure; 6) correlate measures between different ages. The sample included 30 individuals with UCLP and VPD, 15 girls and 15 boys, with mean age of 6y11m. Ten individuals had palatoplasty with FW procedure and 20 with VL, between the ages of 9 and 18 months. For identifying best procedure for correcting VPD all individuals were submitted to videofluoroscopy assessment. A lateral view of the velopharyngeal mechanism during rest was selected and edited into a DVD, for analysis and measurement of the velopharyngeal structures of interest. Three speech-language pathologists experienced in videofluoroscopic assessment obtained all measures studied. The results revealed a mean velar length of 27.4 mm; mean velar thickness of 9.7 mm; mean depth of nasopharynx of 22.7 mm; D/L of 0.86. Comparing these results to Subtelny\'s (1957) a significant difference was found for measures of velar thickness, depth of nasopharynx velar length and D/L. Significant difference was found between males and females only for velar length. No significant differences were found between different techniques for palatoplasty. There was no significant correlation between age and the measurements obtained.

In der Veterinärmedizin existieren nur wenige Veröffentlichungen zur, in der Humanmedizin weitgehend etablierten, Sonographie des Oropharynx. Da vor allem bei brachyzephalen Hunden das Ausmaß der Hyperplasie der oropharyngalen Weichteile, insbesondere des weichen Gaumens, von großem diagnostischen Interesse ist, wird nach Möglichkeiten zur wenig invasiven Untersuchung dieser Region am wachen Patienten gesucht. So war es Ziel dieser kumulativen Dissertation die Grundlagen der sonographischen Untersuchungs- und Messmethode am weichen Gaumen zu erarbeiten. Die Darstellung der sonographischen Anatomie des weichen Gaumens und der Umgebung erfolgte in der ersten Studie an sieben Tierkörpern normozephaler Hunderassen. Die transkutane Untersuchung erfolgte bei submentaler Schallkopfauflage. Zudem kamen speziell geformte Schallköpfe zur direkten Auflage auf den weichen Gaumen in einer intraoralen Untersuchung zum Einsatz. Zur Erleichterung der Identifizierung der anatomischen Strukturen wurden Wasserbad- und sequentielle Ultraschalluntersuchungen im Anschluss an submentale Weichteilpräparationen des Maulhöhlenbodens durchgeführt. Unter Herstellung des Gewebekontaktes zwischen Zunge und weichem Gaumens bei submentaler Schallkopfauflage, gelang die transkutane sonographische Darstellung des weichen Gaumens im kranialen und mittleren Bereich. Der weiche Gaumen wies eine mondsichelähnliche Form und eine geringe Echogenität auf. Als charakteristisch zeigte sich der Übergang von hartem zu weichem Gaumen, die Darstellung des kaudalen Anteils des Gaumensegels ist aufgrund der umgebenen Luft und Überlagerung mit dem Zungenbein nur eingeschränkt möglich. Die intraorale Untersuchung erlaubte die Darstellung der gaumenspezifischen Echotextur. In der zweiten Studie wurde an 15 normozephalen Hunden in Allgemeinanästhesie die Dicke der Gaumensegel sowohl sonographisch als auch computertomographisch an zwei definierten Messpunkten bestimmt. Die Übereinstimmung der Ergebnisse von wiederholten Messungen mit der jeweiligen Messmethode wurde geprüft. Die wiederholten Messungen erzielten sehr gute Übereinstimmungen (Mean absolute deviation von 0), so dass davon ausgegangen werden kann, dass sowohl die Sonographie als auch die CT reproduzierbare Messungen ermöglicht. Im Messmethodenvergleich wurden die Messergebnisse, die mit den unterschiedlichen Messverfahren (Ultraschall und CT) gewonnen wurden, in der Bland-Altman Auswertung miteinander verglichen. Es waren Abweichungen für beide Messpunkte zu verzeichnen, wobei der Mittelwert der Abweichung vor allem für den zweiten Messpunkt mit 0,31 cm als hoch anzusehen ist. Der Mittelwert der Abweichung fällt am ersten Messpunkt mit 0,08 cm geringer aus. Die klinisch relevanten Abweichungen wurden als Folge der zwischen beiden Messmethoden variierenden Untersuchungsbedingungen, insbesondere der abweichenden Patientenlagerung, interpretiert. Sonographie und CT sind damit, trotz guter Reliabilität des einzelnen Verfahrens, als nicht austauschbare Methoden zur Gaumensegeldickenmessung anzusehen. Die transkutane Sonographie ermöglichte, unter den geschilderten Untersuchungs-bedingungen, erstmals eine Darstellung des kranialen und mittleren Anteils des weichen Gaumens. Der kaudale Anteil des Gaumensegels konnte nicht identifiziert werden. Die Sonographie birgt, nach Ermittlung entsprechender Referenzbereiche, das Potential einer nichtinvasiven, schnellen Untersuchungsmethode zur Vermessung der Gaumensegeldicke am wachen Hund.

Terminal restriction fragment length polymorphism (T-RFLP) analysis and pyrosequencing were used to characterize the microbiota of the tonsil of the soft palate of 126 unfit and 18 healthy pigs. The T-RFLP analysis method was first optimized for the study of the pig tonsil microbiota and the data compared with culture-based identification of common pig pathogens. Putative identifications of the members of the microbiota revealed that the phyla Firmicutes, Proteobacteria and Bacteroidetes were the most prevalent. A comparison of the T-RFLP analysis results grouped into clusters to clinical conditions revealed paleness, abscess, PRRS virus, and Mycoplasma hyopneumoniae to be significantly associated with cluster membership. T-RFLP analysis was also used to select representative tonsil samples for pyrosequencing. These studies confirmed Actinobacteria, Bacteroidetes, Firmicutes, Fusobacteria, and Proteobacteria to be the core phyla of the microbiota of the tonsil of the soft palate of pigs. / OMAFRA Animal Health Strategic Investment

Objective: To determine the prevalence and odds ratios for cleft lip and/or palate (CL/P) among infants prenatally exposed to opioids with or without neonatal opioid withdrawal syndrome (NOWS). Design: This study represents an exploratory, retrospective cohort study design of newborn medical health records from 2011 to 2016. Setting: Records were drawn from a regional health system located in South Central Appalachia. Population and Study Sample: The original population yielded 3 cohorts of infants: (1) infants with opioid exposure (OE) but not requiring pharmacological intervention (OE; N = 168); (2) infants with NOWS requiring pharmacological intervention (N = 294); and (3) infants with no opioid exposure (NOE; N = 16 090), the primary comparison group. Main Outcome: Infants in the NOWS and OE groups showed significantly increased prevalence and odds ratios for CL/P when compared to those in the NOE group. Results: Prevalence rates per 1000 live births for infants with OE (35.71) and infants with NOWS (6.80) were significantly higher than those for infants with NOE (1.37). Comparison of infants with OE to the NOE group revealed significantly increased odds for CL/P, isolated cleft palate (CP), cleft lip (CL), and cleft lip and palate (CLP) (27.05, 41.81, 19.26, 19.37, respectively; all Ps <.008). The odds ratios for infants with NOWS compared to the NOE group were significantly higher for CL/P and CP (5.00 and 10.98, respectively; Ps <.03) but not for CL and CLP. Conclusion: The results provide additional evidence that prenatal OE should be considered among the critical environmental risk factors that can contribute to CL/P.

Background: Snoring and obstructive sleep apnea (OSA) are both common disorders with a number of negative health effects. The safety and efficacy of treating snoring and OSA surgically have been questioned and there has been a lack of studies in the field. Aims: 1) To investigate the frequency of serious complications, including death, after surgery for the treatment of snoring and sleep apnea; 2) to evaluate the effect on daytime sleepiness after radiofrequency surgery of the soft palate in snoring men with mild or no OSA; 3) to evaluate the effect of tonsillectomy on sleep apnea in adults with OSA and tonsillar hypertrophy; 4) to investigate the morphology and cytoarchitecture of muscle fibers in human soft palatal muscles with immunohistochemical and morphological techniques. Methods and results: In paper 1, a retrospective database study. All Swedish adults who were treated surgically because of snoring or OSA from January 1997 to December 2005 were identified in the National Patient Register. None of the surgically treated patients died in the peri- and postoperative period. Severe complications were recorded in 37.1 of 1,000 patients treated with uvulopalatopharyngoplasty (UPPP), in 5.6 of 1,000 patients after uvulopalatoplasty (UPP) and in 8.8 of 1,000 patients after nasal surgery. In paper 2, the study was designed as a randomized, controlled trial. 35 snoring men with mild or no OSA were randomized to either radiofrequency or sham surgery of the soft palate. Radiofrequency surgery was not found to be effective since there was no significant difference between the two groups in relation to the Epworth Sleepiness Scale (ESS) or apnea-hypopnea index (AHI) at follow-up. Paper 3 was a prospective study, including 28 patients with an AHI of &gt;10 and with large tonsils. In these patients, tonsillectomy was an effective treatment for OSA; the mean AHI was reduced from 40 units/h to 7 units/h (p&lt;0.001), and the mean ESS was reduced from 10.1 to 6.0 (p&lt;0.001) at the six-month follow-up after surgery. Minor and moderate swallowing dysfunction was found in seven of eight patients investigated before surgery and the swallowing function improved in 5 of them after surgery, while no one deteriorated. In paper 4, we investigated the morphology and cytoarchitecture in normal soft palate muscles. Human limb muscles were used as reference. The findings showed that the soft palate muscle fibers have a cytoskeletal architecture and cellmembrane complex that differs from that of the limb muscles. Conclusions No case of death related to surgery was found among 4,876 patients treated with UPPP, UPP or nasal surgery for snoring or OSA in Sweden between 1997 and 2005. Radiofrequency surgery of the soft palate has no effect on daytime sleepiness, snoring or apnea frequency in snoring men with mild or no OSA. Tonsillectomy can be an effective treatment for OSA in adults with large tonsils. A subgroup of muscle fibers in the human soft palate appears to have special biomechanical properties and their unique cytoarchitecture must be taken into account while assessing function and pathology in oropharyngeal muscles. / Snarkning och obstruktiv sömnapné (OSA) är idag en global folksjukdom. Snarkning är det ”oljud” som uppstår när luftvägen under sömn förminskas och vävnaden börjar vibrera under andning. Vid obstruktiv sömnapné faller vävnaden samman och blockerar luftflödet till lungorna. Ett andningsuppehåll, en s.k. apné inträffar. Ett andningsuppehåll kan pågå allt ifrån några sekunder till mer än en minut och kan uppstå hundratals gånger per natt. För att klassificeras som en patologisk apné enligt internationell standard måste andningsuppehållet vara längre än 10 sek. Snarksjukdomen förvärras sannolikt över tid och övergår succesivt i obstruktiv sömnapné med ökande antal andningsuppehåll under sömn. Detta leder till ett stresspåslag för kroppen med oftast uttalad dagtrötthet och en mängd negativa hälsoeffekter. Snarksjukdom och sömnapné ökar risken för bl.a. högt blodtryck och hjärt-kärlsjukdom samt också för att den drabbade ska orsaka trafikolyckor på grund av försämrad koncentrationsförmåga och trötthet. En del av den negativa utvecklingen från snarkning till sömnapné anses bero på att snarkvibrationer kan ge neuromuskulära skador i gom och svalg. Dessa vävnadsskador anses också vara orsaken till att personer som snarkat länge ofta uppvisar störd sväljningsfunktion i form av felsväljning, där maten i uttalade fall hamnar i luftstrupen istället för i matstrupen. I dagsläget är förstahandsbehandling vid sömnapné CPAP, en mask som placeras över näsa och mun och som skapar ett övertryck i luftvägen vilket förhindrar att luftvägen faller samman och att andningsstopp uppstår. CPAP har enligt flera studier den bästa effekten mot andningsuppehåll. En annan vanlig behandling är en bettskena som för underkäken nedåt och framåt så att luftvägen bli mer öppen. Bettskenan är en vanlig och effektiv behandlingsmetod för personer utan kraftig övervikt vid vanemässig snarkning eller måttlig sömnapné. För ett tjugotal år sedan var kirurgi förstahandsmetoden vid behandling av snarkning och måttlig sömnapné. Man utförde då ofta operationer i svalg och gomm, s.k. gomplastiker. Bruket av kirurgisk behandling har dock minskat med tiden, dels p.g.a. biverkningar men också för att det saknades vetenskapliga studier som bevisade att kirurgin gav önskad och långsiktig effekt. Kirurgi utgör dock fortfarande ett komplement till behandling av snarkning och sömnapné när CPAP eller bettskena av olika skäl inte fungerar eller kan tolereras av patienten. 8 Även barn kan lida av snarkning och sömnapné men behandlingsprinciperna för barn skiljer sig från dem hos vuxna och berörs inte i avhandlingen. I denna avhandling studeras: i) biverkningsfrekvenser efter olika typer av snarkkirurgi, ii) effekten av radiovågsbehandling i mjuka gommen på vuxna män med snarkning, iii) effekten av att operera bort halsmandlarna på vuxna med sömnapné och stora halsmandlar, iv) muskelvävnadens struktur och molekylära uppbyggnad i mjuka gommen hos friska personer som inte snarkar. Avhandlingen består av fyra delstudier: 1. En registerstudie med kartläggning av svåra biverkningar efter kirurgi i form av uvulopalatopharyngoplastik, uvulupalatoplastik samt näskirurgi för behandling av sömnapné och snarkning och utfört i Sverige mellan åren 1997-2005. Studien omfattade 4 876 patienter. Inga dödsfall noterades. Komplikationsrisken var störst vid operationer där man tog bort delar av mjuka gommen samt halsmandlarna, där i snitt 37 av 1000 opererade fick biverkningar, framförallt p.g.a. infektioner eller blödningar. 2. I en prospektiv, randomiserad placebostudie utvärderades effekten av radiovågsbehandling i mjuka gommen vid snarkning och lindrig sömnapne. Trettiotvå patienter lottades till att få radiovågsbehandling eller placebo behandling. Patienterna visste inte vilken grupp de tillhörde. Vid uppföljning efter 12 månader var det inga statistiska belägg för att radiovågsbehandling minskade vare sig antal andningsuppehåll eller dagtrötthet. 3. Effekten av att ta bort halsmandlarna på patienter med stora halsmandlar och olika grad av sömnapné utvärderades i denna studie. Totalt deltog 28 patienter. Vid uppföljning 6 månader efter operationen hade antalet andningsuppehåll sjunkit drastiskt, från i snitt 40 till 7 andningsuppehåll per timme nattsömn. Inga allvarliga biverkningar uppstod. Dessa fynd talar för att man som förstahandsmetod ska erbjuda patienter med sömnapné och stora halsmandlar att ta bort halsmandlarna. 4. I detta projekt undersökte vi utseendet och uppbyggnaden av cellskelettet i två normala muskler i mjuka gommen hos friska personer utan känd snarkning och sömnapné. Muskler från armar och ben användes som referens. Fynden i studien visar att de normala muskelfibrernas uppbyggnad i mjuka gomen skiljer sig från jämförade muskler i armar och ben. Detta kan vara ett uttryck för en evolutionär utveckling för att möjligöra de komplexa funktioner som krävs av svalgets muskulatur. 9 Sammanfattningsvis kan vi konstatera: Att inga dödsfall har skett i Sverige efter operationer i gom, svalg eller näsa, utförda för att behandla snarkning och sömnapné under åren 1997 till 2005. Att radiovågsbehandling av mjuka gommen hos snarkande män med lindrig sömnapné inte har någon effekt på dagtrötthet, snarkning eller andningsuppehåll vid uppföljning efter 12 månader. Metoden kan därför inte rekommenderas. Att när man opererar bort stora halsmandlar på personer med andningsuppehåll så leder detta ofta till att andningsuppehållen minskar drastiskt. Metoden kan därför oftast rekommenderas som en förstahandsbehandling för denna patientgrupp. Att mjuka gommens muskelfibrer är uppbyggda på ett unikt sätt indikerar att deras specifika biomekaniska egenskaper skiljer sig från referens muskler i armar och ben.

Snoring is a sleep disruption that can lead to obstructive sleep apnea (OSA), which interrupts breathing by obstructing the airway. Injecting a protein crosslinker, such as genipin, into the soft palate could decrease the severity of snoring and OSA by stiffening the soft palate. Equine soft palates modeled human palates due to a high incidence of awake snoring and apnea. The pilot in vivo study treated six horses with two 100 mM injections of the buffered genipin reagent. The efficacy phase horses underwent respiratory audio recordings to document snoring changes using Matlab and ImageJ in the time and frequency domains. Histological analysis was completed on the safety phase palates post treatment. All horses were successfully treated with the genipin injections. At least one horse showed high frequency amplitude reductions, and all horses had low frequency amplitude reductions, correlating to a reduction in palatal displacement and snoring loudness. One efficacy horse appears to have been completely cured. The histological analysis presented tissue damage, mucosal tissue damage, and mild inflammation due to palate expansion and errant injections. Different injection volumes and techniques should be investigated next. Applying this treatment to human studies for snoring and OSA applications is the ultimate goal.