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Gabriela Bosco
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8Years (2019-Present)
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Representative Publications
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Journal Article
PFPatricia Fernandez-Sanjuan
Patricia Fernandez-SanjuanJAJuan José Arrieta
Juan José ArrietaJSJaime Sanabria
Jaime Sanabria
Marta Alcaraz FuentesGBGabriela Bosco
Gabriela BoscoGPGuillermo Plaza
Guillermo Plaza +8
Mandibular advancement devices (MAD) are an effective alternative treatment to CPAP. Different maneuvers were performed during drug sleep-induced endoscopy (DISE) to mimic the effect of MAD. Using the Selector Avance Mandibular (SAM) device, we aimed to identify MAD candidates during DISE using a titratable, reproducible, and measurable maneuver. This DISE-SAM protocol may help to find the relationship between the severity of the respiratory disorder and the degree of response and determine the advancement required to improve the collapsibility of the upper airway. Explorations were performed in 161 patients (132 males; 29 females) with a mean age of 46.81 (SD = 11.42) years, BMI of 27.90 (SD = 4.19) kg/m2, and a mean AHI of 26.51 (SD = 21.23). The results showed no relationship between severity and MAD recommendation. Furthermore, there was a weak positive relationship between the advancement required to obtain a response and the disease severity. Using the DISE-SAM protocol, the response and the range of mandibular protrusion were assessed, avoiding the interexaminer bias of the jaw thrust maneuver. We suggest prescribing MAD as a single, alternative, or multiple treatment approaches following the SAM recommendations in a personalized design.
Journal Article
GBGabriela Bosco
Gabriela BoscoMMMarta Morato
Marta MoratoNPNuria Perez
Nuria PerezANAndres Navarro
Andres NavarroMRMiguel A. Racionero
Miguel A. RacioneroGPGuillermo Plaza
Guillermo Plaza +2
We report the results of one-stage multilevel upper airway surgery for patients who could not tolerate continuous positive airway pressure (CPAP). Patients treated with multilevel surgery at a University Hospital in 2015–2019 were identified from a prospectively maintained database. The inclusion criteria were aged 18–70 years, body mass index (BMI) < 35 kg/m2, apnea–hypopnea index (AHI) > 20, and lingual tonsil hypertrophy grade 3 or 4. Drug-induced sleep endoscopy was performed before surgery in all patients. Multilevel surgery was performed in one stage and included expansion sphincter pharyngoplasty (ESP), coblation tongue base reduction (CTBR), and partial epiglottectomy (PE) as required. The outcome measures were postoperative AHI, time percentage oxygen saturation < 90%, and Epworth Sleepiness Scale (ESS) score. A total of 24 patients were included: median age 49.1 years, average BMI 27.26 kg/m2, and 90% men. Ten patients received ESP plus CTBR plus PE, eight received ESP plus CTBR, and six received ESP plus PE. The mean preoperative AHI was 33.01 at baseline and improved to 17.7 ± 13 after surgery (p < 0.05). The ESS score decreased from 11 ± 5.11 to 7.9 ± 4.94 (p < 0.05). The surgical success rate according to Sher’s criteria was 82.3%. The median follow-up was 23.3 months (range 12–36). These findings suggest that multilevel surgery is a safe and successful treatment of OSAHS.
Journal Article
PFPatricia Fernandez-Sanjuan
Patricia Fernandez-SanjuanMarta Alcaraz FuentesGBGabriela Bosco
Gabriela BoscoNPNuria Perez
Nuria PerezMGMarta Morato Galan
Marta Morato GalanGPGuillermo Plaza
Guillermo Plaza +4
Background: Mandibular advancement devices (MADs) are an effective treatment for patients with sleep-related breathing disorders, with variable response. Increasingly more research points to the predictive value of Drug-Induced Sleep Endoscopy (DISE) in patient selection. This study aims to analyze the changes in upper airway collapsibility using a titratable MAD simulator during DISE. Methods: This study included 104 patients with simple snoring and obstructive sleep apnea (OSA). The VOTE scale was used to assess the presence of collapses during the DISE both without and with the MAD simulator. Results: In snorers, there was a decrease in collapses at the level of the soft palate and oropharynx when the advancement was achieved. Patients with mild OSA also showed a decrease in collapses at the base of the tongue. Patients with moderate/severe OSA exhibited significant amelioration at all levels. The levels at which there were residual collapses despite the maneuver were, in order, the velopharynx, oropharynx, epiglottis, and tongue. Conclusions: The MAD simulator reduces collapsibility at all levels and in all severity groups. Residual collapses suitable for combined treatments were able to be identified. This highlights the need for individualized patient selection, as upper airway collapsibility exhibits variable improvement or worsening with the MAD simulator regardless of the severity of the condition.
1 July 2019 in Acta Otorrinolaringológica Española
Journal Article
GBGabriela Bosco
Gabriela BoscoNPNuria Pérez-Martín
Nuria Pérez-Martín
MRMiguel A. Racionero
Miguel A. Racionero
GPGuillermo Plaza
Guillermo Plaza
About Me
Dynamic professional. Highlighted areas of interest: snoring and sleep medicine: certified expert in otorhinolaryngology, expert in sleep respiratory disorder surgery, board certified in sleep respiratory disorder surgery, and endorsed by A.I.M.S. Worked at the Hospital of Forli (Italy) with Prof. Vicini, head and neck oncology; in the Department of Head and Neck Surgery with Dr. Jatin Shah, Memorial Sloan Kettering Cancer Center; and in the broad and innovative field of nasosinusal endoscopic surgery, undergoing surgical training at the University of Miami Miller School of Medicine. Qualified person accustomed to working in the area of pediatric otorhinolaryngology.
Doctor of Medicine and Surgery, Rey Juan Carlos University, Spain, Outstanding, cum laude (unanimously). Title: Effect of Otolaryngology Surgery in the Upper Airway: Usefulness of Somnoscopy (DISE—drug-induced sleep endoscopy).
Specialist in Otolaryngology, University Hospital October 12, Madrid, 2009-2013.
Otolaryngology expert qualified in sleep respiratory disorder surgery, board certified in sleep respiratory disorder surgery, endorsed by A.I.M.S., September 2016, Rome, Italy.
Collaborating Professor at the Rey Juan Carlos University.
Member of the Ibero–American Society of Sleep Surgery for Spain and Portugal.
Member of the Spanish Society of Otolaryngology and Head and Neck Surgery.
Member of the Ilustrious College of Physicians of Madrid.