Fibrovascular polyps of the esophagus are uncommon, benign intraluminal growths. Their gradual growth and vague symptoms often lead to delays in diagnosis, placing patients at risk for serious complications such as sudden airway obstruction caused by regurgitation. We present a case involving a 56-year-old woman who experienced a two-year history of a foreign body sensation in her throat and a six-month history of an intermittently protruding mass in her mouth. Despite numerous consultations and several indirect laryngoscopic examinations, no abnormalities were identified, resulting in a delayed diagnosis. Dynamic videolaryngoscopy performed during the gag reflex revealed a smooth pedunculated mass protruding into the oral cavity from the right side. Imaging studies showed dilatation of the upper and middle esophagus along with a long intraluminal soft tissue mass. Flexible upper gastrointestinal endoscopy revealed a large polypoidal lesion with a long pedicle originating from the right lateral wall just above the cricopharynx and extending into the esophagus. Surgical treatment was carried out using a combined approach involving tracheostomy, direct hypopharyngoscopy, and left lateral pharyngotomy, allowing safe identification, ligation, and complete removal of the mass. Histopathological analysis confirmed the presence of a giant fibrovascular polyp. The postoperative recovery was uneventful, and the patient remains symptom-free during follow-up. This case emphasizes the diagnostic challenges associated with giant fibrovascular polyps and highlights the importance of dynamic assessment and prompt surgical intervention to prevent life-threatening complications.

Background: Obstructive sleep apnea (OSA) is increasingly recognized as a systemic disorder associated with insulin resistance and elevated risk of type 2 diabetes. While continuous positive airway pressure (CPAP) is the standard therapy, its long-term metabolic benefits remain inconsistent. The metabolic impact of upper airway surgery is less well defined. Methods: In this retrospective study, 49 patients with polysomnography-confirmed OSA who underwent upper airway surgery were evaluated. Respiratory and metabolic parameters-including apnea-hypopnea index (AHI), fasting plasma glucose, fasting insulin, glycated hemoglobin (HbA1c), and homeostatic model assessment for insulin resistance (HOMA-IR)-were assessed preoperatively and at 6 months postoperatively. Associations between changes in AHI (ΔAHI) and insulin resistance (ΔHOMA-IR) were analyzed using correlation and receiver operating characteristic (ROC) analyses. Results: Significant improvements were observed in both respiratory and metabolic parameters. AHI decreased from 46.6 ± 25.8 to 20.7 ± 14.1 events/h (p < 0.001). Fasting plasma glucose, insulin levels, and HOMA-IR were significantly reduced postoperatively (all p < 0.05), while HbA1c showed a downward trend. Reduction in AHI was moderately correlated with improvement in insulin resistance (r = 0.527, p < 0.001). ROC analysis demonstrated modest discriminative ability of ΔAHI for identifying normalization of insulin resistance (AUC = 0.62). Conclusions: Upper airway surgery was associated with significant improvements in insulin resistance and glycemic parameters in patients with OSA. The correlation between airway improvement and metabolic change supports a physiological link between upper airway obstruction and insulin sensitivity. These findings suggest that upper airway surgery may represent a clinically relevant adjunct within multimodal strategies for metabolic risk reduction, particularly in patients unable to tolerate CPAP therapy.

Background: Extubation failure (EF) is a significant complication, and it is associated with increased mortality, prolonged hospital stays and extended mechanical ventilation (MV). Determining reliable predictors of EF could improve the clinical decision-making and outcomes. Objectives: Determine the outcomes and predictors of EF in a paediatric intensive care unit (PICU) and develop predictive models using machine learning algorithms. Methods: A retrospective cohort study (n = 824) was conducted in two PICUs in participants who underwent planned extubation (January 2018-December 2022). Demographic characteristics, clinical parameters, ventilator setting, laboratory findings and extubation outcomes were collected. Univariate and multivariate analysis were performed to identify significant predictors of EF. Six machine learning algorithms-Logistic Regression (LR), Artificial Neural Network (ANN), Extreme Gradient Boosting (XGBoost), Random Forest (RF), Support Vector Machine (SVM) and Decision Tree (DT)-were developed and validated for prediction of EF. Results: The overall EF rate was 231 (28%). Multivariate analysis identified a mechanical ventilation for a duration of 3 days or more (aOR 4.49, 95% CI 3.24-6.57, p < 0.001), use of neuromuscular blockade (aOR 1.32, 95% CI 1.07-1.63, p = 0.009), and administration of vasopressors (aOR 1.57, 95% CI 1.24-2.01, p < 0.001) as significant independent predictors of EF. The ANN and LR models demonstrated the highest performance with AUCROC of 0.87 ± 0.04 and 0.86 ± 0.02, respectively. Conclusions: Extubation failure was common in our setting (28%) compared to other studies. Days of ventilation, undernutrition, use of neuromuscular blockade, use of vasopressors or inotropes and CNS comorbidity were associated with EF. The main cause of EF was upper airway obstruction.

The upper airway is a complex structure, prone to repetitive collapse in obstructive sleep apnoea (OSA). This review discusses the pathophysiological aspects of OSA, with a focus on the anatomy and pathophysiology of upper airway obstruction. This disorder is characterised by different mechanisms that constitute its pathology, which may all contribute to apnoea presence and severity. These include pharyngeal anatomy, collapsibility, upper airway muscle responsiveness, loop gain and arousal threshold. Identification of interindividual differences in the underlying mechanisms of OSA offers promise for a more targeted approach to OSA management.

A rare congenital nasopharyngeal hairy polyp was incidentally identified during an attempted adenoidectomy in a 15-month-old female. The patient presented with snoring and intermittent apnea concerning for upper airway obstruction. Magnetic resonance imaging (MRI) revealed a 2.5-cm partially enhancing nasopharyngeal mass along the soft palate, likely originating near the left nasopharyngeal wall or Eustachian tube orifice. The lesion was excised transorally without complications. Histopathological analysis confirmed a benign hairy polyp composed of mature adipose tissue, skeletal muscle, and cartilage, lined by keratinized squamous epithelium with underlying adnexa including pilosebaceous units. Postoperatively, the patient's symptoms resolved. Interval postoperative MRI surveillance is planned for 6 months. This case highlights the importance of considering rare congenital lesions within the differential diagnosis of pediatric obstructive sleep symptoms. Early recognition and diagnosis can lead to appropriate surgical planning and better outcomes for these patients.

Sleep-disordered breathing reflects the interplay of upper-airway collapsibility, sleep depth/arousability, and instability in ventilatory control. Ventilatory loop gain (LG) quantifies the latter as the ratio of ventilatory response to disturbance: values >1 indicate self-sustaining oscillations, whereas lower values denote stable control. Despite its clinical relevance, LG measurement remains largely confined to research laboratories because conventional protocols (e.g., controlled gas challenges, stepwise reductions in positive airway pressure) are invasive and technically demanding. Recent advances have enabled several computable LG estimation methods from signals available in routine polysomnography and selected home settings, creating a timely opportunity to translate LG beyond the laboratory. Indirect approaches include breath-hold maneuvers, cardiopulmonary-coupling metrics, respiratory self-similarity analysis, and data-driven or model-based estimation. Simplified surrogates improve accessibility but sacrifice physiological detail, whereas model-based methods (e.g., Phenotyping Using Polysomnography [PUP]) provide individualized LG profiles at higher requirements for signal quality and computation. Emerging evidence from model-based polysomnographic estimation indicates that a dynamic LG threshold near 0.7 may help identify patients who benefit from chemorespiratory stabilizers alongside obstruction-resolving therapies, whereas those with lower LG often respond adequately to anatomy-focused approaches alone; whether equivalent thresholds apply across estimation methods remains to be established. Prior reviews have emphasized physiology and phenotype-based care, but none have systematically compared LG assessment methods across a fidelity-feasibility spectrum or linked method choice to treatment selection and validation needs. This review synthesizes perturbation tests, signal-based surrogates, and model-based identification into a pragmatic framework with decision cues for screening versus confirmatory testing and priorities for clinical deployment.

Measuring asynchrony between the thorax and abdomen during sleep provides information about inspiratory effort and upper airway obstruction in children, aiding in the diagnosis of obstructive sleep apnea (OSA). This study aimed to define a normative range for thoracoabdominal asynchrony (TAA) in healthy children by studying polysomnographies of 113 children aged 10-13 years. The percentage of total sleep time (TST) spent with elevated TAA, > 40°, was measured, as well as obstructive apnea-hypopnea index (OAHI), sleep position, sleep stage and snoring. Subjects without measurable OSA (N = 94) were defined as healthy subjects and they had elevated TAA for an average of 3.3% of their TST while subjects with OSA (N = 19) had elevated TAA for 10.7% of their TST (p < 0.00001). The cut-off point for the normal prevalence of elevated TAA was estimated at 9.6% of TST, which can be rounded up to 10% for ease of use. TAA prevalence rose in REM-sleep and in the supine position and was related to increased snoring. Children with obesity had higher OAHI, more prevalent TAA and more snoring. No gender differences were observed. Parent-reported PSQ scores showed limited concordance with objective measures. TAA assessment, available from standard RIP-bands placed around chest and abdomen, may aid in the interpretation of sleep studies in children, both home sleep apnea tests and polysomnographies. With further research, they might help guide clinical decision making in paediatric sleep medicine.