Victor F. Certal

Hospital CUF Porto · Centro Medico da Praça Ovar, São João da Madeira e Sta Maria da Feira

Introduction Hypoglossal nerve stimulation (HGNS) improves sleep-disordered breathing (SDB), oxygenation, and quality of life (QOL) in obstructive sleep apnea (OSA), but to date, has not been shown to improve cardiovascular outcomes. The THN3 randomized, controlled trial of proximal HGNS included subjects with office systolic blood pressure (SBP) ≤...

Introduction The THN3 randomized, controlled trial of moderate to severe obstructive sleep apnea (OSA) showed that proximal (“targeted”) hypoglossal nerve stimulation (HGNS) safely improved sleep-disordered breathing (SDB) and quality of life (QOL) through 11 months of treatment. Outcomes of subjects receiving active proximal HGNS also surpassed th...

Importance: Evidence is lacking from randomized clinical trials of hypoglossal nerve stimulation in obstructive sleep apnea (OSA). Objective: To evaluate the safety and effectiveness of targeted hypoglossal nerve stimulation (THN) of the proximal hypoglossal nerve in patients with OSA. Design, setting, and participants: This randomized clinica...

Introduction THN3 was the first reported parallel-arm, randomized controlled trial of hypoglossal nerve stimulation (HGNS), wherein targeted HGNS (THN) was shown to be safe and efficacious at ameliorating sleep disordered breathing in selected patients with moderate to severe OSA and BMI≤35kg/m2 without screening with drug-induced sleep endoscopy....

Introduction THN3 was the first reported parallel-arm, randomized controlled trial (RCT) of hypoglossal nerve stimulation (HGNS), wherein targeted HGNS (THN) was shown to be safe and efficacious at ameliorating sleep disordered breathing in patients with moderate to severe OSA and BMI≤35kg/m2 without screening with drug-induced sleep endoscopy. Uni...

Objectives Intermittent hypoxemia is a risk factor for developing complications in obstructive sleep apnea (OSA) patients. The objective of this systematic review was to identify articles evaluating the accuracy of the oxygen desaturation index (ODI) as compared with the apnea–hypopnea index (AHI) and then provide possible values to use as a cutoff...

Obstructive Sleep Apnea (OSA) Syndrome has been related to disturbances in couple harmony and has been related to low adherence to treatment. This study aimed to understand the experience of sleeping difficulties in the relationship of couples with OSA, its impact on the family and the importance of the partner regarding patient’s adherence to trea...

Background The purpose of the present study is to review the international literature, using a systematic review, for studies comparing propofol and dexmedetomidine for drug-induced sleep endoscopy (DISE) or sedation in which there is a description of the effect of the agents on the upper airway and associated variables (e.g., vital signs, sedation...

Obstructive sleep apnea is a highly prevalent and poorly understood condition that not only leads to significant individual patient health damage, but carries a large societal cost secondary to excessive healthcare utilization, motor-vehicle accidents, and work absenteeism. While a significant fund of knowledge about its damaging effects on the car...

Introduction Targeted Hypoglossal Neurostimulation (THN) is a novel treatment for OSA that aims to stimulate selective tongue muscles using a 6-contact cuff, placed around the hypoglossal nerve trunk. Selective stimulation and cycling between contacts is used to minimize risk of neuromuscular fatigue. From earlier safety and feasibility trials, pre...

Objectives/Hypothesis To perform a systematic review with meta-analysis for sleep study outcomes in children who have undergone rapid maxillary expansion (RME) as treatment for obstructive sleep apnea (OSA). Data Sources PubMed/MEDLINE and eight additional databases. Review Methods Three authors independently and systematically reviewed the inte...

Objective: To systematically search for studies reporting outcomes for adenoidectomy alone as a treatment for paediatric obstructive sleep apnoea and use the data to perform a meta-analysis. Methods: Nine databases, including PubMed and Medline, were systematically searched through to 1 April 2016. The Preferred Reporting Items for Systematic Re...

Objective To evaluate the clinical and histopathological factors affecting the prognosis of patients with squamous cell locoregional advanced laryngeal cancer. Methods A retrospective chart review was conducted of 121 patients with locoregional advanced laryngeal cancer, primarily treated with surgery from 2007 to 2011. Disease-free survival and o...

Background : Qualitative studies aimed at describing the experience lived by couples or bed partners, where at least 1 have OSA are scarce. Thus, the present study sought to fill this gap. Objective: To describe the different speeches between patients with OSA and their bed partners, assisted in a Public Hospital in the North of Portugal. Method: 2...

Objective: To perform a systematic review and meta-analysis for studies evaluating genioplasty alone, genial tubercle advancement (GTA) alone, and GTA with hyoid surgery (GTA-HS) to treat obstructive sleep apnea (OSA). Data sources: Ten databases. Review methods: Three authors searched through November 15, 2015. Results: 1,207 studies were s...

A maior parte do que sabemos sobre O Síndrome da Apneia Obstrutiva do Sono (SAOS) vem de estudos individuais. No entanto, para a maioria dos adultos, o sono é um evento comum entre os casais ou parceiros de cama tendo por isso impacto no relacionamento conjugal. Estudos qualitativos visando descrever a experiência vivida por esses casais, assim com...

Objectives/Hypothesis To determine if sleepiness and sleep study variables (e.g., Apnea-Hypopnea Index [AHI] and lowest oxygen saturation) improve following isolated tonsillectomy for adult obstructive sleep apnea (OSA). Study Design Systematic review and meta-analysis. Methods Nine databases (PubMed/MEDLINE included) were searched through Novemb...

This is an update to the recent meta-analysis on expansion sphincter pharyngoplasty.

Objective This study sought to systematically review the international literature for articles evaluating maxillary expansion and maxillomandibular expansion as treatments for obstructive sleep apnea (OSA) in adults and to perform a meta-analysis. Data Sources Nine databases (including MEDLINE/PubMed). Review Methods Searches were performed throu...

Objectives/Hypothesis The primary objective was to determine if sleep study variables (e.g., apnea-hypopnea index [AHI] and lowest oxygen saturation) and quantitative sleepiness data improve following isolated hyoid surgery for obstructive sleep apnea (OSA). Study Design Systematic review and meta-analysis. Methods Nine databases, including Pu...

Objective: To evaluate the effect of turbinate sizes on the titrated continuous positive airway pressure (CPAP) therapeutic treatment pressures for patients with obstructive sleep apnea (OSA) who have not had nasal surgery. Study design: Retrospective case series. Methods: A chart review was performed for 250 consecutive patients. Results: 45 pa...

Objective: To systematically review the international literature for internal nasal septal deviation classification systems and summarize them for clinical and research purposes. Data sources: PUBMED, Scopus, Web of Science and the Cochrane Library with a timeframe from inception of the respective databases through July 22, 2015 for the identifica...

Objective: To develop a quick, simple, bedside test for determining continuous positive airway pressures (CPAP) for obstructive sleep apnea (OSA) patients. Study Design: Prospective case series at a tertiary medical center. Methods: The Five-Minute Awake Snoring Test for Determining CPAP Pressures (Five-Minute CPAP Test) was developed and tested....

Objective: To search the international literature for articles evaluating the use of tracheostomies (either permanent stomas or with tracheostomy tubes) in adult obstructive sleep apnea (OSA) patients and to evaluate the potential for the use of mini tracheostomies as treatment for OSA. Study design: Systematic review. Methods: Nine databases we...

Unlabelled: Objective. To evaluate the association between nasal obstruction and (1) demographic factors, (2) medical history, (3) physical tests, and (4) nasal exam findings. Study Design. Case series: Methods. Chart review at a tertiary medical center. Results. Two hundred-forty consecutive patients (52.1 ± 17.5 years old, with a Nasal Obstruc...

Objectives/Hypothesis To determine if apnea-hypopnea index (AHI) and lowest oxygen saturation (LSAT) improve following isolated supraglottoplasty for laryngomalacia with obstructive sleep apnea (OSA) in children. Study Design Systematic review and meta-analysis. Methods Nine databases, including PubMed/MEDLINE, were searched through September 30,...

Objective. To quantify the effectiveness of nasal expiratory positive airway pressure (nasal EPAP) devices or Provent as treatment for obstructive sleep apnea (OSA). Methods. PubMed and six other databases were searched through November 15, 2015, without language limitations. Results. Eighteen studies (920 patients) were included. Pre- and post-nas...

Importance Maxillomandibular advancement (MMA) is an invasive yet effective surgical option for obstructive sleep apnea (OSA) that achieves enlargement of the upper airway by physically expanding the facial skeletal framework.Objective To identify criteria associated with surgical outcomes of MMA using aggregated individual patient data from mult...

Objective: Traditionally, upper airway examination is performed while the patient is awake. However, in the past two decades, drug-induced sleep endoscopy (DISE) has been used as a method of tridimensional evaluation of the upper airway during pharmacologically induced sleep. This study aimed to systematically review the evidence regarding the use...

A common surgical treatment for obstructive sleep apnea (OSA) is uvulopalatopharyngoplasty (UPPP). Unfortunately, traditional UPPP can cause a foreign body sensation, chronic discomfort and in rare cases, nasopharyngeal stenosis or velopharyngeal insufficiency. Modifications to traditional UPPP have been developed over the years to help decrease si...

Objective: To identify and systematically evaluate user-friendly smartphone snoring apps. Methods: The Apple iTunes app store was searched for snoring apps that allow recording and playback. Snoring apps were downloaded, evaluated and rated independently by four authors. Two patients underwent polysomnography, and the data were compared with simul...

Objective: To systematically review the international literature for mathematical equations used to predict effective positive airway pressure (PAP) device pressures. Methods: Google Scholar, PubMed, Scopus, Embase, Web of Science, CINAHL and The Cochrane Library were searched through June 27, 2015. The PRISMA statement was followed. There was no...

Obstructive sleep apnea (OSA) is a syndrome frequently diagnosed in children; however, it lacks optimal diagnostic methods. This study aimed to provide a clinical decision rule for predicting pediatric OSA using commonly available clinical information. A prospective cohort study. Children between the ages of 3 to 6 years-old, referred for an otorhi...

Objective: Obstructive sleep apnea (OSA) can be a challenging disorder to treat. Maxillomandibular advancements (MMAs) generally have high success rates; however, larger advancements have higher success and cure rates. Our aim is to present and to describe the current technique used by the senior authors, which has been successful for performing la...

Objectives: Patients with obstructive sleep apnea (OSA) often face the challenge of how to power their PAP devices when alternating current power supplies are not available in remote areas with a lack of electricity or frequent power outages. This review elucidates portable power supply options for PAP devices with the aim to increase alternative p...

Objective The objective of this study is to systematically review polysomnography data and sleepiness in morbidly obese (body mass index [BMI] ≥40 kg/m2) patients with obstructive sleep apnea (OSA) treated with either a maxillomandibular advancement (MMA) or a tracheostomy and to evaluate the outcomes. Data Sources MEDLINE, Scopus, Web of Science...

Objectives/hypothesis: To develop a validated inferior turbinate grading scale. Study design: Development and validation study. Methods: Phase 1 development (alpha test) consisted of a proposal of 10 different inferior turbinate grading scales (>1,000 clinic patients). Phase 2 validation (beta test) utilized 10 providers grading 27 standardize...

The objective of this study was to systematically assess the evidence for the diagnostic accuracy of unattended type 2 or type 3 multichannel studies for predicting and monitoring pediatric obstructive sleep apnea (OSA). Four medical databases were searched for eligible studies. Only studies that evaluated the ability of unattended multichannel dev...

Objective: To systematically review outcomes of adults with obstructive sleep apnoea treated with nasopharyngeal airway stenting devices. Methods: Medline, Scopus, Web of Science and the Cochrane Library databases were searched, and data on device use and tolerability, sleepiness, oxygen saturation, apnoea index, apnoea–hypopnoea index, and sleep...

Objectives/HypothesisPoor adherence to continuous positive airway pressure treatment in obstructive sleep apnea (OSA) adversely affects the effectiveness of this therapy. This study aimed to systematically review the evidence regarding the efficacy and safety of hypoglossal nerve stimulation as an alternative therapy in the treatment of OSA.Data So...

Objective To systematically review the literature for articles evaluating myofunctional therapy (MT) as treatment for obstructive sleep apnea (OSA) in children and adults and to perform a meta-analysis on the polysomnographic, snoring, and sleepiness data. Data Sources Web of Science, Scopus, MEDLINE, and The Cochrane Library. Review Methods The s...

Background: The relationship between nasal surgery and its effect on continuous positive airway pressure (CPAP) device therapeutic treatment pressures and CPAP device use has not been previously systematically examined. Study Objectives: To conduct a systematic review and meta-analysis evaluating the effect of isolated nasal surgery on therape...

To systematically review outcomes for polysomnography, sleepiness, and mortality in patients who undergo tracheostomy for the treatment of adult obstructive sleep apnea (OSA). MEDLINE, Scopus, and the Cochrane Library were searched from inception to March 2013, followed by extensive hand searching for the identification of relevant English language...

There are several surgical treatment modalities utilized for obstructive sleep apnea syndrome (OSAS). OSAS can cause excessive daytime sleepiness as well as cardiovascular morbidity and mortality. Patients who fail medical management often seek surgical treatment. This paper reviews surgical treatment options for obstructive sleep apnea syndrome to...

Objective There is an extensive amount of literature on surgeries as treatment for obstructive sleep apnea syndrome on adults. Previous systematic reviews have been performed to summarize the outcomes for sleep surgeries, with conflicting results. The objective of this study was to critically evaluate these systematic reviews to provide an overview...

Several organizations and individual authors have been proposing quality indicators for the assessment of clinical care in HIV/AIDS patients. Nevertheless, the definition of a consensual core set of indicators remains controversial and its practical use is largely limited. This study aims not only to identify and characterize these indicators throu...

Clinical symptoms and signs are routinely used to investigate pediatric obstructive sleep apnea (OSA). This study aimed to systematically assess the evidence for the diagnostic accuracy of individual or combined clinical symptoms and signs in predicting pediatric OSA. A systematic review of the literature and diagnostic meta-analysis. Four medical...

Trans-septal suturing techniques are routinely used to obviate the need for packing after septoplasty surgery. This study aimed to systematically assess the evidence for the efficacy and safety of suturing techniques after septoplasty. A MEDLINE, Scopus, Cochrane Library, and ProQuest Dissertations & Thesis Database search, followed by extensive ha...

Objectives The goal of this study was to make a review of the patients who underwent ossicular chain reconstruction with titanium prosthesis during an eight-year period in our Department.

The goal of this study was to make a review of the patients who underwent ossicular chain reconstruction with titanium prosthesis during an eight-year period in our Department. A retrospective study was made on the ossiculoplasty cases over a period of eight years in a Public Hospital District. The information was extracted by clinical process cons...