Robson Capasso's research while affiliated with Stanford Medicine and other places

Publications (104)

Article
Study objectives: Untreated obstructive sleep apnea (OSA) is associated with excessive daytime sleepiness, decreased quality of life, and cardiovascular disease. Positive airway pressure (PAP) is the first-line therapy for OSA, however, adherence is difficult. Upper airway stimulation (UAS) is an FDA approved treatment of OSA. The objective of thi...
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PurposeTo analyze upper airway (UA) collapse patterns through drug-induced sleep endoscopy (DISE) in adult patients with obstructive sleep apnea (OSA) who previously underwent tonsillectomy.Methods This was a retrospective study on patients with OSA who underwent DISE between June 1, 2013 and July 30, 2017 at Stanford Hospital. Subjects who had pri...
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Background: Telemedicine has grown significantly in recent years, mainly during the COVID-19 pandemic, and there has been a growing body of literature on the subject. Another topic that merits increased attention is differences in patient and family experience between telehealth and in-person visits. To our team's knowledge, this is the first stud...
Article
Study objectives: To assess the incidence and risk factors of chronic opioid use after OSA surgery. Methods: Using IBM MarketScan research database, adults (>18) who underwent a variety of sleep surgery procedures between 2007 and 2015, were identified. Subjects with one year of insurance coverage before and after the surgical procedure were inc...
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Objective Determine risk factors for failure to receive surgical treatment among patients with obstructive sleep apnea. Study Design Population-based observational longitudinal cohort study. Setting Population-based database. Methods Multivariate analysis of 500,792 individuals with obstructive sleep apnea from Optum’s deidentified Clinformatics...
Article
Background: Patients with narrow high-arch palate present with limited response to standard septal, turbinate, and valve procedures for nasal obstruction. Objective: To measure the effectiveness of minimally invasive nasal endoscopic (MINE) Lefort I osteotomy among subjects with narrow high-arched palate in managing nasal obstruction. Methods: Pros...
Article
Objective Uvulopalatopharyngoplasty (UPPP) is performed as a surgical treatment at the oropharyngeal level for obstructive sleep apnea, but there are problems with variations in treatment effects and postoperative complications. Therefore, to improve those, we have devised and put into practice the so-called CWICKs, which is a modified version of b...
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Objective Upper airway surgery is a common therapeutic approach recommended for patients with obstructive sleep apnea (OSA) to decrease disease burden. We aimed to evaluate the effect of perioperative antibiotic prescription on complication rates. Study Design Retrospective cohort (national database). Setting Tertiary referral center. Methods Th...
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In Reply We are happy the findings of our recent study¹ have attracted the attention of diligent readers and sparked some interesting discussion on the role of surgery in the treatment algorithm of obstructive sleep apnea (OSA).
Article
Background: Rate of corrective nasal surgery after maxillomandibular advancement (MMA) for obstructive sleep apnea (OSA) has been reported to be 18.7% for functional and aesthetic indications. Objective: Describe a comprehensive strategy to optimize nasal outcomes with MMA for OSA. Methods: A retrospective review of patients undergoing MMA for OSA...
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Objective To discuss the virtual management options and strategies learned during the COVID-19 pandemic for treatment of patients with sleep complaints and sleep disordered breathing presenting to the otolaryngologist. Methods/Results The addition of a virtual evaluation can be beneficial in assessing the patient presenting to the otolaryngologist...
Article
Objective Nasal surgery fails to restore nasal breathing in some cases. Maxillary constriction is suggested as a major cause of failure. It is thought that maxillary constriction leads to the closure of the internal and external nasal valves. Moreover, it is well established in the literature that maxillary expansion, both in adults and children, i...
Article
Importance The efficacy of surgical treatments for obstructive sleep apnea (OSA) is variable when considering only the Apnea Hypopnea Index as the treatment end point. However, only a few studies have shown an association between these procedures and improved clinically relevant outcomes, such as cardiovascular, endocrine, and neurological sequelae...
Preprint
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Purpose: Identification of upper airway (UA) obstruction based on pharyngeal factors is important for obstructive sleep apnea (OSA) evaluation. This study is to assess the association between UA collapse characteristics and Friedman tongue position (FTP) in patients with OSA through drug-induced sleep endoscopy (DISE). Patients and methods: Retr...
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Objective: COVID-19 patients may present mild symptoms. The identification of paucisymptomatic patients is paramount in order to interrupt the transmission chain of the virus. Olfactory loss could be one of those early symptoms which might help in the diagnosis of COVID-19 patients. In this study, we aim to develop and validate a fast, inexpensive,...
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Background: The Friedman staging is a classic system to predict outcomes of obstructive sleep apnea (OSA) surgery. Increasing stage indicates more severe upper airway (UA) obstruction and worse surgical successful rate. In previous studies, the UA obstruction between stages were usually assessed based on awake examination. Drug-induced sleep endos...
Article
OBJECTIVE A reduced transversal dimension of the maxilla leads to narrower nasal cavities, which may reduce airflow to the lungs. Maxillary expansion widens nasal floor. However, there is huge controversy regarding whether this increase does actually lead to increased airflow. In this systematic review and meta-analysis we aim to resolve this quest...
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OBJECTIVE Inferior turbinates are the main structure related to impaired nasal breathing. When medical treatment fails, surgery is the next step, according to clinical guidelines. However, despite the widespread acceptance of this procedure, there is some controversy about performing it in children. DATA SOURCES Pubmed (Medline), the Cochrane Libr...
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This article focuses on the role of skeletal surgery within the modified Stanford protocol with particular attention focused on the evolved role of MMA. First, surgery in patients presenting with congenital dentofacial deformity or characteristic drug-induced sleep endoscopy findings, then the growing role of maxillary expansion in a newly identifi...
Article
Since the outbreak of novel coronavirus disease (COVID-19) in December 2019, it has spread to various regions and countries, forming a global pandemic. Reducing nosocomial infection is a new issue and challenge for all healthcare systems. Otolaryngology is a high-risk specialty as it close contact with upper respiratory tract mucous, secretions, dr...
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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...
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Objective: To determine if a modified tissue-preserving palatopharyngoplasty could convert retropalatal concentric collapse to anteroposterior or lateral patterns of collapse on drug-induced sleep endoscopy (DISE) in patients who are not candidates for upper airway stimulation due to complete circumferential collapse at the velum. Methods: A pro...
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Background: To systematically review the literature for methods to localize the genial tubercle as a means for performing an advancement of the genioglossus muscle. Methods: PubMed, Google Scholar, CRISP, EMBASE, CINAHL, and Scopus were searched from inception through June 16, 2015. Results: One hundred fifty-two articles were screened, and th...
Article
Introduction While studies have demonstrated hypoglossal nerve stimulation (HNS) to be a safe and overall effective treatment for certain patients with obstructive sleep apnea (OSA), not all who meet current selection criteria respond to therapy. In an effort to elucidate better criteria for patient selection, this study aimed to look at the effect...
Article
Whereas the original Stanford protocol relied on a tiered approach to care to avoid unnecessary surgery, it did not address the issue of surgical relapse, a common concern among sleep medicine specialists. With 3 decades of experience since the original 2-tiered Powell-Riley protocol was introduced and the role of evolving skeletal techniques and u...
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Purpose of Review The consumer market for devices that quantify sleep is quickly evolving. We conducted a review of the consumer technology available for sleep disorders, including its potential and limitations to screen obstructive sleep apnea (OSA). Recent Findings There are many commercial devices claiming to objectively measure sleep, but only...
Article
Objective To evaluate the association between findings of blinded reviews of preoperative drug‐induced sleep endoscopy (DISE) examinations using the VOTE Classification and obstructive sleep apnea (OSA) surgical outcomes in a large multicenter, international cohort. Methods Retrospective, multi‐center cohort study of adults without tonsillar hyper...
Article
Objective: Continuous positive airway pressure (CPAP) is the mainstay therapy for patients with obstructive sleep apnea (OSA) however compliance with CPAP is variable. Nasal ailments, such as nasal congestion are frequently mentioned as a cause for CPAP non-compliance, and potentially could be addressed prior to CPAP initiation, however, no specif...
Article
Objectives/hypothesis: Examine US and international clinical trials in obstructive sleep apnea (OSA) to characterize researchers involved, interventions being studied, and opportunities for future investigation. Study design: Retrospective database review. Methods: The information from ClinicalTrials.gov was used to assess OSA clinical trials...
Article
What we already know about this topic: WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Evidence suggests that obstructive sleep apnea promotes postoperative pulmonary complications by enhancing vulnerability to opioid-induced ventilatory depression. We hypothesized that patients with moderate-to-severe obstructive sleep apnea are more sensiti...
Article
Introduction: Positive airway pressure (PAP) devices are generally considered to be the first-line treatment of choice for most adults with obstructive sleep apnea (OSA). However, there are several alternatives. It is important for patients and their sleep providers to be aware of the most-up to date information regarding the current international...
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Objective Drug‐induced sleep endoscopy (DISE) has gained interest for upper airway evaluation in patients with snoring and obstructive sleep apnea (OSA), and different drugs have been used to induce sedation. Nevertheless, all drugs have presented specific advantages and disadvantages with differential effects on respiratory physiology. This study...
Article
Objectives/Hypothesis To evaluate the correlation of aging and upper airway collapse characteristics observed by drug‐induced sleep endoscopy (DISE), and report the observed differences on obstructive sleep apnea (OSA) subjects, older and younger than 60 years. Study Design Case series. Methods This study analyzed the data of 200 OSA patients who...
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Study objectives: Sleep disorders in most individuals remain undiagnosed and without treatment. The use of novel tools and mobile technology has the potential to increase access to diagnosis. The objective of this study was to perform a quantitative and qualitative analysis of the available literature evaluating the accuracy of smartphones and por...
Article
Study objectives: Patients suspected to have sleep-disordered breathing underwent an overnight polysomnography using a divided nasal cannula to gain additional information about the nasal cycle during sleep. Methods: This was a prospective, observational cohort study replacing the undivided nasal cannula with a divided nasal cannula during routi...
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Purpose Assess the quality of information on obstructive sleep apnea (OSA) presented on YouTube for patients. Materials and methods “Obstructive sleep apnea” was entered into the YouTube search. Two independent reviewers categorized and analyzed videos utilizing a customized scoring-system along with search position, likes, and views. Results For...
Article
Objectives/Hypothesis Examine trends in clinical research and levels of evidence related to obstructive sleep apnea (OSA) in the medical literature. Describe the features and trends of OSA research within otolaryngology journals. Study Design Retrospective analysis. Methods Review of OSA research articles from 2006, 2011, and 2016 in four lead...
Article
Objective: To validate the use of Cormack-Lehane and Modified Cormack-Lehane scoring systems to classify patterns of hypopharyngeal airway visualization seen during awake flexible laryngoscopy among patients with obstructive sleep apnea. Study design: Validation study using samples collected from a prospective database. Setting: University Med...
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Study objectives: The relationship among obstructive sleep apnea (OSA), body mass index (BMI), and testosterone levels has long been suggested. Obese men have shown a negative correlation between testosterone level and sleep apnea severity. Yet, little is known about the association between testosterone levels and sleep apnea in men who are not ob...
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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...
Chapter
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...
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Introduction Successful surgical management of obstructive sleep apnea (OSA) is based upon determining the pattern of upper airway obstruction and design of a tailored treatment. Drug-Induced sleep endoscopy (DISE) is an evaluation using pharmacologic sedation designed to simulate natural sleep. DISE has shown promise in studies at single instituti...
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Background Patients are accessing online health information frequently and using it to guide treatment decisions. Few studies have been done assessing obstructive sleep apnea (OSA) information, and no studies have examined surgical resources for these patients. Methods This was a cross-sectional analysis. “Sleep surgery” and “sleep apnea surgery” w...
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Objectives/hypothesis: Our objectives were to describe otolaryngology residency programs' experience in and attitudes toward sleep surgery, and describe current otolaryngology sleep fellowships and their impact on future academic practice. Study design: E-mail survey. Methods: A survey was e-mailed to program directors of 106 Accreditation Cou...
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Background Nasal obstruction is a common problem in patients with obstructive sleep apnea (OSA). Systematic evaluation of nasal obstruction remains challenging due to the high number of variables and factors that contribute to nasal obstruction. Nasal examination by means of anterior rhinoscopy is limited to the evaluation of anterior septal deviat...
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Objective Assess the frequency and nature of postoperative complications following sleep surgery. Examine these issues specifically in elderly patients to provide guidance for their perioperative care. Study Design Retrospective cohort study. Setting American College of Surgeons National Surgical Quality Improvement Program. Methods We identifie...
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Objectives: The primary objective of the study was to understand the differential impact of continuous positive airway pressure (CPAP) on the location, degree and pattern of airway collapse in obstructive sleep apnea (OSA) patients utilizing drug-induced sleep endoscopy (DISE). Study design: Non-randomized trial. Setting: University Medical Ce...
Article
Objective Tongue Retaining Devices (TRD) anteriorly displace the tongue with suction forces while patients sleep. TRD provide a non-surgical treatment option for patients with Obstructive Sleep Apnea (OSA). Our objective was to conduct a systematic review of the international literature for TRD outcomes as treatment for OSA. Methods Three authors...
Article
Objective The objective of this study was to systematically review the international literature for studies providing a preoperative checklist for medical disorders to be evaluated or treated before performing sleep surgery. If no checklist exists, then the identified studies would be used to develop a checklist de novo. Study design Systematic...
Chapter
Surgeons interested in TORS in 2015 are at a distinct advantage compared to the early adapters, as much of the groundwork has been completed. For the many who have adopted TORS as part of their armamentarium for the treatment of OSA, the environment in North America (USA) has allowed many centers to flourish, each with its own unique experiences. I...
Article
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...
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Objective To compare VOTE classification findings (velum, oropharyngeal-lateral walls, tongue base, and epiglottis) for drug-induced sleep endoscopy (DISE) among patients with obstructive sleep apnea (OSA) using 2 sedation protocols. Study Design Case series with chart review. Setting Single tertiary institution. Subjects Patients with OSA wh...
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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....
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Objective: To study the feasibility of a standard nasopharyngeal airway tube (NPAT) as treatment for snoring. Methods: An obese 35 year old man, who is a chronic, heroic snorer used NPATs while: 1) the patient’s bedpartner scored the snoring, and 2) the patient recorded himself with the smartphone snoring app “Quit Snoring”. Baseline snoring was 8...
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Objectives To use drug-induced sedation endoscopy (DISE) and computational fluid dynamics (CFD) modeling to study dynamic airway and airflow changes after maxillomandibular advancement (MMA), and how the changes correlate with surgical success based on polysomnography parameters. Study Design Retrospective cohort study. Setting University medical...
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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...
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Objective: Although sleep impairment is reported by patients with chronic rhinosinusitis, the associated factors have not been well studied. Therefore, we determined the associated risk factors for sleep impairment in patients with chronic rhinosinusitis (CRS). Methods: This study was a prospective cohort study. A total of 572 adult patients (17...
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Objectives: Using sleep MRI, we aimed to identify static craniofacial measurements and dynamic upper airway collapse patterns associated with severe obstructive sleep apnea (OSA) during natural sleep in age and BMI matched patients. Design: Nested case-control study. Setting: Sleep MRI images (3.0 Tesla scanner) and synchronized acoustic recor...
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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...
Article
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...
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Radiofrequency ablation of the inferior turbinates (RFAIT) is a minimally invasive surgical technique that reduces turbinate size and decreases nasal obstruction. Few studies have assessed long-term outcomes of this procedure using standardized, symptom-specific evaluation instruments. The primary aim of this study is to assess the long-term effect...