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Jang J, Kim YW, Park JH, Mun SJ, Kim SD, Cho KS. Predictors of surgical outcomes for limited palatal muscle resection in patients with obstructive sleep apnea. Am J Otolaryngol 2024; 45:104110. [PMID: 37944346 DOI: 10.1016/j.amjoto.2023.104110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/17/2023] [Accepted: 10/29/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE Limited palatal muscle resection (LPMR) is a modified palatal surgical technique to correct retropalatal obstruction without complications. This study aims to determine the associated factors affecting the success and cure rate of LPMR in patients with obstructive sleep apnea (OSA), thus guiding patient selection and improving surgical outcome. METHODS Thirty-five OSA patients underwent LPMR were enrolled. All patients received routine physical examination, preoperative drug-induced sleep endoscopy (DISE), and polysomnography (PSG). Clinical, polysomnographic, cephalometric variables, and DISE findings were evaluated. These measurements were compared between the surgical success and failure group based on the results of preoperative and postoperative PSG. Furthermore, we compared the cured and non-cured groups in the surgical success group. RESULTS Among 35 patients, the overall success rate was 57 % with a cure rate of 31.4 %. Patients with Friedman stage II had a significantly higher success rate (p = 0.032). According to DISE results, tongue base obstruction affected the surgical outcome (p < 0.001). The success rate was 100 % in the no tongue base obstruction during DISE, 72.2 % in the partial obstruction, and 9.1 % in the total obstruction. Tonsil size is also helpful in predicting surgical success rate (p = 0.041). Furthermore, patients with mild AHI were more likely to be surgical cures. when compared with patients with severe AHI (p = 0.044). CONCLUSION Patients with larger tonsil size and no tongue base obstruction during DISE may have a higher chance of surgical success with LPMR. The lower AHI may be predictors of surgical cure after LPMR.
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Affiliation(s)
- JiWon Jang
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Yong-Wan Kim
- Department of Otorhinolaryngology, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Ji-Hwan Park
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Sue Jean Mun
- Department of Otorhinolaryngology and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Sung-Dong Kim
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Kyu-Sup Cho
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Republic of Korea.
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Chang JL, Goldberg AN, Alt JA, Alzoubaidi M, Ashbrook L, Auckley D, Ayappa I, Bakhtiar H, Barrera JE, Bartley BL, Billings ME, Boon MS, Bosschieter P, Braverman I, Brodie K, Cabrera-Muffly C, Caesar R, Cahali MB, Cai Y, Cao M, Capasso R, Caples SM, Chahine LM, Chang CP, Chang KW, Chaudhary N, Cheong CSJ, Chowdhuri S, Cistulli PA, Claman D, Collen J, Coughlin KC, Creamer J, Davis EM, Dupuy-McCauley KL, Durr ML, Dutt M, Ali ME, Elkassabany NM, Epstein LJ, Fiala JA, Freedman N, Gill K, Boyd Gillespie M, Golisch L, Gooneratne N, Gottlieb DJ, Green KK, Gulati A, Gurubhagavatula I, Hayward N, Hoff PT, Hoffmann OM, Holfinger SJ, Hsia J, Huntley C, Huoh KC, Huyett P, Inala S, Ishman SL, Jella TK, Jobanputra AM, Johnson AP, Junna MR, Kado JT, Kaffenberger TM, Kapur VK, Kezirian EJ, Khan M, Kirsch DB, Kominsky A, Kryger M, Krystal AD, Kushida CA, Kuzniar TJ, Lam DJ, Lettieri CJ, Lim DC, Lin HC, Liu SY, MacKay SG, Magalang UJ, Malhotra A, Mansukhani MP, Maurer JT, May AM, Mitchell RB, Mokhlesi B, Mullins AE, Nada EM, Naik S, Nokes B, Olson MD, Pack AI, Pang EB, Pang KP, Patil SP, Van de Perck E, Piccirillo JF, Pien GW, Piper AJ, Plawecki A, Quigg M, Ravesloot MJ, Redline S, Rotenberg BW, Ryden A, Sarmiento KF, Sbeih F, Schell AE, Schmickl CN, Schotland HM, Schwab RJ, Seo J, Shah N, Shelgikar AV, Shochat I, Soose RJ, Steele TO, Stephens E, Stepnowsky C, Strohl KP, Sutherland K, Suurna MV, Thaler E, Thapa S, Vanderveken OM, de Vries N, Weaver EM, Weir ID, Wolfe LF, Tucker Woodson B, Won CH, Xu J, Yalamanchi P, Yaremchuk K, Yeghiazarians Y, Yu JL, Zeidler M, Rosen IM. International Consensus Statement on Obstructive Sleep Apnea. Int Forum Allergy Rhinol 2023; 13:1061-1482. [PMID: 36068685 PMCID: PMC10359192 DOI: 10.1002/alr.23079] [Citation(s) in RCA: 62] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.
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Affiliation(s)
- Jolie L. Chang
- University of California, San Francisco, California, USA
| | | | | | | | - Liza Ashbrook
- University of California, San Francisco, California, USA
| | | | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | - Maurits S. Boon
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pien Bosschieter
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Itzhak Braverman
- Hillel Yaffe Medical Center, Hadera Technion, Faculty of Medicine, Hadera, Israel
| | - Kara Brodie
- University of California, San Francisco, California, USA
| | | | - Ray Caesar
- Stone Oak Orthodontics, San Antonio, Texas, USA
| | | | - Yi Cai
- University of California, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | - Susmita Chowdhuri
- Wayne State University and John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Peter A. Cistulli
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David Claman
- University of California, San Francisco, California, USA
| | - Jacob Collen
- Uniformed Services University, Bethesda, Maryland, USA
| | | | | | - Eric M. Davis
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Mohan Dutt
- University of Michigan, Ann Arbor, Michigan, USA
| | - Mazen El Ali
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | - Kirat Gill
- Stanford University, Palo Alto, California, USA
| | | | - Lea Golisch
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | | | | | - Arushi Gulati
- University of California, San Francisco, California, USA
| | | | | | - Paul T. Hoff
- University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver M.G. Hoffmann
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | - Jennifer Hsia
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Colin Huntley
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Sanjana Inala
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Meena Khan
- Ohio State University, Columbus, Ohio, USA
| | | | - Alan Kominsky
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Meir Kryger
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Derek J. Lam
- Oregon Health and Science University, Portland, Oregon, USA
| | | | | | | | | | | | | | - Atul Malhotra
- University of California, San Diego, California, USA
| | | | - Joachim T. Maurer
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Anna M. May
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Ron B. Mitchell
- University of Texas, Southwestern and Children’s Medical Center Dallas, Texas, USA
| | | | | | | | | | - Brandon Nokes
- University of California, San Diego, California, USA
| | | | - Allan I. Pack
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | - Mark Quigg
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Armand Ryden
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Firas Sbeih
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | | | | | | | | | - Jiyeon Seo
- University of California, Los Angeles, California, USA
| | - Neomi Shah
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Ryan J. Soose
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Erika Stephens
- University of California, San Francisco, California, USA
| | | | | | | | | | - Erica Thaler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sritika Thapa
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nico de Vries
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | | | - Ian D. Weir
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Josie Xu
- University of Toronto, Ontario, Canada
| | | | | | | | | | | | - Ilene M. Rosen
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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O'Connor-Reina C, Alcala LR, Ignacio JM, Iriarte MTG, Llatas MC, Morente JCC, Del Rey DP, Alvarez IM, Ibarburu GH, Baptista P, Plaza G. Risk of diabetes in patients with sleep apnea: comparison of surgery versus CPAP in a long-term follow-up study. J Otolaryngol Head Neck Surg 2023; 52:16. [PMID: 36788636 PMCID: PMC9930296 DOI: 10.1186/s40463-022-00616-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 12/14/2022] [Indexed: 02/16/2023] Open
Abstract
This study aimed to obtain a comprehensive view of the risk of developing diabetes in patients with obstructive sleep apnea (OSA) and to compare this risk between patients receiving continuous positive airway pressure (CPAP) therapy versus upper airway surgery (UAS). We used local and the global-scale federated data research network TriNetX to obtain access to electronic medical records, including those for patients diagnosed with OSA, from health-care organizations (HCOs) worldwide. Using propensity score matching and the score-matched analyses of data for 5 years of follow-up, we found that patients who had undergone UAS had a lower risk of developing diabetes than those who used CPAP (risk ratio 0.415, 95% confidence interval (CI) 0.349-0.493). The risk for newly diagnosed diabetes patients showed a similar pattern (hazard ratio 0.382; 95% CI 0.317-0.459). Both therapies seem to protect against diabetes (Risk 0.081 after UAS vs. 0.195 after CPAP). Analysis of the large data sets collected from HCOs in Europe and globally lead us to conclude that, in patients with OSA, UAS can prevent the development of diabetes better than CPAP.
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Affiliation(s)
- Carlos O'Connor-Reina
- Otorhinolaryngology Department, Hospital Quironsalud Marbella, 29680, Marbella, Spain.
- Otorhinolaryngology Department, Hospital Quironsalud Campo de Gibraltar, Palmones, Spain.
| | - Laura Rodriguez Alcala
- Otorhinolaryngology Department, Hospital Quironsalud Marbella, 29680, Marbella, Spain
- Otorhinolaryngology Department, Hospital Quironsalud Campo de Gibraltar, Palmones, Spain
| | | | | | | | | | - David Perez Del Rey
- Biomedical Informatics Group, Universidad Politécnica de Madrid, Madrid, Spain
| | | | | | - Peter Baptista
- Otorhinolaryngology Department, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Guillermo Plaza
- Otorhinolaryngology Department, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, Spain
- Otorhinolaryngology Department, Hospital Sanitas la Zarzuela, Madrid, Spain
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Shaikh N, Tumlin P, Greathouse Z, Bulbul MG, Coutras SW. Effects of Soft Tissue Sleep Surgery on Morbidly Obese Patients. Ann Otol Rhinol Laryngol 2023; 132:138-147. [PMID: 35227070 DOI: 10.1177/00034894221081098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Morbidly obese patients with obstructive sleep apnea (OSA) are often intolerant of continuous positive airway pressure (CPAP). The effects of sleep surgery in this population is not well documented, and sleep surgery is generally avoided due to the expectation of poor outcomes, leaving these patients untreated. METHODS This retrospective study included 42 patients with a body mass index (BMI) ≥40.0 and OSA with a preoperative apnea hypopnea index (AHI) ≥5. Preoperative BMI ranged from 40.0 to 69.0 kg/m2. Preoperative AHI ranged from 7.2 to 130.0. Of 42 patients, 12 (28.6%) underwent concurrent pharyngeal and retrolingual surgery. Subgroup analysis of change in AHI was measured with respect to preoperative OSA severity, change in preoperative BMI, and BMI severity. Univariate linear and logistic regression was performed assessing change in AHI and surgical success with respect to age, sex, preoperative AHI, preoperative BMI, change in BMI, total procedures, palatal procedure, retrolingual procedure, nasal procedure, and multilevel procedures. RESULTS The mean AHI improved from 45.9 ± 31.8 to 31.9 ± 31.6 (P = .007). Epworth sleepiness score (ESS) improved from 13.2 ± 5.5 to 9.6 ± 5.4 (P = .00006). Lowest oxygen saturation (LSAT) improved from 74.4 ± 10.7 to 79.9 ± 10.4 (P = .002). About 33.3% of patients had surgical success (AHI < 20 with at least 50% reduction in AHI). Preoperative AHI was the most significant factor for change in AHI in univariate and multivariate models (P = .015). CONCLUSION Sleep surgery is effective in reducing OSA burden in most morbidly obese patients and can result in surgical cure for a third of patients.
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Affiliation(s)
- Noah Shaikh
- Otolaryngology Department, West Virginia University, Morgantown, WV, USA
| | - Parker Tumlin
- Otolaryngology Department, West Virginia University, Morgantown, WV, USA
| | | | - Mustafa G Bulbul
- Otolaryngology Department, West Virginia University, Morgantown, WV, USA
| | - Steven W Coutras
- Otolaryngology Department, West Virginia University, Morgantown, WV, USA
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Tondo P, Fanfulla F, Sabato R, Scioscia G, Foschino Barbaro MP, Lacedonia D. Obstructive sleep apnoea-hypopnoea syndrome: state of the art. Minerva Med 2023; 114:74-89. [PMID: 35766549 DOI: 10.23736/s0026-4806.22.08190-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Obstructive sleep apnoea-hypopnoea syndrome (OSAHS) is an extremely common sleep-related breathing disorder (SRBD) characterised by complete or partial collapse of the upper airways. These nocturnal phenomena cause high-frequency hypoxemic desaturations (or intermittent hypoxia, IH) during sleep and alterations in gas exchange. The result of IH is the development or worsening of cerebro-cardio-vascular, metabolic and other diseases, which cause a high risk of death. Hence, OSAHS is a multifactorial disease affecting several organs and systems and presenting with various clinical manifestations involving different medical branches. Although it has been estimated that about one billion individuals worldwide are affected by OSAHS, this SRBD remains underestimated also due to misinformation regarding both patients and physicians. Therefore, this review aims to provide information on the main symptoms and risk factors for the detection of individuals at risk of OSAHS, as well as to present the diagnostic investigations to be performed and the different therapeutic approaches. The scientific evidence reported suggest that OSAHS is an extremely common and complex disorder that has a large impact on the health and quality of life of individuals, as well as on healthcare expenditure. Moreover, given its multifactorial nature, the design and implementation of diagnostic and therapeutic programmes through a multidisciplinary approach are necessary for a tailor-made therapy for each patient.
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Affiliation(s)
- Pasquale Tondo
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy - .,Respiratory and Intermediate Care Unit, Department of Specialistic Medicine, "Policlinico Riuniti" University Hospital of Foggia, Foggia, Italy - .,Respiratory Function and Sleep Medicine Unit, IRCCS Istituti Clinici Scientifici "Maugeri", Pavia, Italy -
| | - Francesco Fanfulla
- Respiratory Function and Sleep Medicine Unit, IRCCS Istituti Clinici Scientifici "Maugeri", Pavia, Italy
| | - Roberto Sabato
- Respiratory and Intermediate Care Unit, Department of Specialistic Medicine, "Policlinico Riuniti" University Hospital of Foggia, Foggia, Italy
| | - Giulia Scioscia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.,Respiratory and Intermediate Care Unit, Department of Specialistic Medicine, "Policlinico Riuniti" University Hospital of Foggia, Foggia, Italy
| | - Maria Pia Foschino Barbaro
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.,Respiratory and Intermediate Care Unit, Department of Specialistic Medicine, "Policlinico Riuniti" University Hospital of Foggia, Foggia, Italy
| | - Donato Lacedonia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.,Respiratory and Intermediate Care Unit, Department of Specialistic Medicine, "Policlinico Riuniti" University Hospital of Foggia, Foggia, Italy
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Kim BK, Park SI, Hong SD, Jung YG, Kim HY. Volume of parapharyngeal fat pad in obstructive sleep apnea syndrome: prognostic role for multilevel sleep surgery. J Clin Sleep Med 2022; 18:2819-2828. [PMID: 35962943 PMCID: PMC9713906 DOI: 10.5664/jcsm.10230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 08/04/2022] [Accepted: 08/04/2022] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVES To evaluate the prognostic role of volume of parapharyngeal fat pad (VPPFP) after multilevel sleep surgery in patients with obstructive sleep apnea syndrome. METHODS This retrospective cohort study was conducted in 50 patients with moderate to severe obstructive sleep apnea syndrome who underwent polysomnography (preoperative and postoperative 6 months) and preoperative facial computed tomography with multilevel sleep surgery between May 2010 and February 2019. All patients had failed or refused positive airway pressure treatment. RESULTS Of the 50 patients with moderate to severe obstructive sleep apnea syndrome who underwent multilevel sleep surgery, 46 were male (92.0%) with mean ± standard deviation age of 41.2 ± 12.5 years. On the preoperative polysomnography, mean ± standard deviation of apnea-hypopnea index and CT90 (cumulative percentage of time spent at oxygen saturation less than 90%) were 43.4 ± 19.3 events/h and 5.6 ± 9.6%, respectively. The average VPPFP measured by facial computed tomography scan was 4.9 ± 1.9 cm3. Multiple linear regression analysis showed that VPPFP was significantly correlated (R2 = 0.38) with age (β = 0.05; 95% confidence interval [CI], 0.01-0.09) and body mass index (β = 0.31; 95% CI, 0.16-0.45). Surgical success rate was 38%, and VPPFP higher than 5.1 cm3 was significantly associated with surgical failure after covariate adjustment (P = .01; odds ratio = 0.09; 95% CI, 0.02-0.48). Postoperative apnea-hypopnea index was positively correlated (R2 = 0.40) with CT90 (β = 1.33; 95% CI, 0.74-1.92) and VPPFP (β = 3.52; 95% CI, 0.30-6.74). CONCLUSIONS VPPFP correlated with age and body mass index, and high VPPFP and CT90 were associated with high postoperative apnea-hypopnea index. VPPFP larger than 5.1 cm3 was a possible risk factor for surgical failure, which may inform a decision on multilevel sleep surgery as salvage therapy for positive airway pressure treatment. CITATION Kim BK, Park SI, Hong SD, Jung YG, Kim HY. Volume of parapharyngeal fat pad in obstructive sleep apnea syndrome: prognostic role for multilevel sleep surgery. J Clin Sleep Med. 2022;18(12):2819-2828.
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Affiliation(s)
- Byung Kil Kim
- Department of Otorhinolaryngology–Head and Neck Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Song I. Park
- Department of Otorhinolaryngology–Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sang Duk Hong
- Department of Otorhinolaryngology–Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yong Gi Jung
- Department of Otorhinolaryngology–Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyo Yeol Kim
- Department of Otorhinolaryngology–Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Abstract
Uvulopalatopharyngoplasty is a generally safe and widely accepted surgical procedure for the treatment of obstructive sleep apnea. Unfortunately, uvulopalatopharyngoplasty does not always result in success, and patients who initially experienced improvement in the severity of their obstructive sleep apnea may relapse. Proper patient selection and performing uvulopalatopharyngoplasty in conjunction with other surgical procedures that are directed at other sites of upper airway collapsibility may yield favorable outcomes.
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Should Multilevel Phase I Surgical Therapy be Recommended as Treatment for Moderate Obstructive Sleep Apnea due to Oropharyngeal and Hypopharyngeal Obstruction? J Oral Maxillofac Surg 2020; 78:2282-2288. [PMID: 32898482 DOI: 10.1016/j.joms.2020.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/07/2020] [Accepted: 08/07/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the efficacy of multilevel phase I surgery for the treatment of moderate obstructive sleep apnea (OSA) in retrognathic patients with oropharyngeal and hypopharyngeal obstruction. MATERIALS AND METHODS This was a 10-year retrospective cohort study of patients treated by a single surgeon at the Boston University Medical Center. From 2000 to 2010, retrognathic patients with moderate OSA and verified palatal and tongue base obstruction were treated with multilevel phase I surgery that included uvulopalatopharyngoplasty, hyoid suspension, and genioglossus advancement. All patients were evaluated clinically and received polysomnographic studies at three time points: preoperatively (T1), between 6 and 12 months postoperatively (T2), and a minimum of 24 months postoperatively (T3). RESULTS Twenty-five subjects composed the final study sample. At T2, 11 patients (44.0%) experienced a complete response, 13 (52.0%) experienced a partial response, and 1 (4.0%) experienced no response. Although phase I surgery was associated with significant changes in AHI (F(2,48) = 119.3; P < .01) throughout the follow-up period, only one patient at T3 (4.0%) met the criteria for a complete response. The remaining patients were divided evenly between partial response (48.0%) and treatment failure (48.0%), of whom 4 (16.0%) patients had worsening of their obstruction. Thirteen of these patients subsequently elected to undergo maxillomandibular advancement, while 11 elected to continue using continuous positive airway pressure. CONCLUSIONS Although phase I surgery was associated with AHI changes, this reduction was not sufficient to produce a long-term treatment response in over half of our patients. Treatment response was worse after 2 years than at 6 to 12 months. Patients with moderate OSA should understand that multilevel phase I surgery has a greater chance of failure than success and that transient improvements may not be durable.
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Sun N, Ye J, Zhang J, Kang D, Tai J, Wang S, Zhang J, Ni X. Efficacy of Velopharyngeal Surgery for Positional Obstructive Sleep Apnea Hypopnea Syndrome. EAR, NOSE & THROAT JOURNAL 2020; 100:999S-1003S. [PMID: 32525699 DOI: 10.1177/0145561320931956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Positional obstructive sleep apnea hypopnea syndrome (P-OSAHS) is a distinct OSAHS type. Whether velopharyngeal surgery is efficacious for patients with P-OSAHS remains unclear. AIM/OBJECTIVE To investigate the efficacy and factors influencing velopharyngeal surgery for treatment of patients with P-OSAHS, defined as the apnea hypopnea index (AHI) in different body postures (supine AHI ≥2*nonsupine AHI). MATERIALS AND METHODS A total of 44 patients with P-OSAHS who underwent velopharyngeal surgery were retrospectively studied. The clinical data of these patients, including polysomnography (PSG), physical examination, and surgical information, were collected for analysis. All patients underwent a PSG about 6 months after surgery to determine the treatment outcomes. RESULTS The overall AHI of the 44 patients decreased from 40.2 ± 18.7 events/h to 18.5 ± 17.5 events/h after surgery (P < .001). There were 29 responders (65.9%) according to the classical definition of surgical success. The percentage of sleep time with oxygen saturation below 90% (CT90) was the only predictive parameter for surgical success (P = .014, odds ratio value = 0.894). There was no significant difference between the change in supine AHI (-55.9 ± 35.2%) and the change in nonsupine AHI (-43.4 ± 74.1%; P = .167), and these 2 parameters were significantly correlated (r = 0.616, P < .001). Among the 38 patients with residual OSAHS (residual AHI ≥5), 28 had persistent P-OSAHS, and the percentage was as high as 82.4%. CONCLUSIONS AND SIGNIFICANCE Patients with P-OSAHS with a lower CT90 value are more likely to benefit from velopharyngeal surgery. Positional therapy could be indicated for most of the patients who are not cured by such surgery.
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Affiliation(s)
- Nian Sun
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jingying Ye
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Junbo Zhang
- Department of Otolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, China
| | - Dan Kang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jun Tai
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Shengcai Wang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jie Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xin Ni
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Yin G, He M, Cao X, Xu J, Zhang Y, Kang D, Ye J. Five-Year Objective and Subjective Outcomes of Velopharyngeal Surgery for Patients with Obstructive Sleep Apnea. Otolaryngol Head Neck Surg 2019; 162:148-154. [PMID: 31635534 DOI: 10.1177/0194599819884889] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the long-term effects of velopharyngeal surgery on objective and subjective symptoms in patients with obstructive sleep apnea (OSA). STUDY DESIGN Prospective cohort study. SETTING University medical center. SUBJECTS AND METHODS Eighty-six patients with OSA underwent velopharyngeal surgery, which consisted of revised uvulopalatopharyngoplasty with uvula preservation, with or without concomitant transpalatal advancement pharyngoplasty. The results from polysomnography and the Epworth Sleep Scale after 6 months and 5 years were compared with baseline. Baseline variables were compared between responders and nonresponders. RESULTS Sixty-three patients were successfully followed up at the end of study. The surgical success rate after 6 months and 5 years was 66.67% (42 of 63) and 60.32% (38 of 63), respectively, with no significant difference (P = .459). The apnea-hypopnea index and Epworth Sleep Scale dramatically decreased from baseline after 6 months and 5 years in responders and nonresponders (P < .001 for all). As compared with nonresponders, the responders exhibited larger tonsil size, higher nocturnal lowest oxygen desaturation, lower CT90 (percentage of time with oxygen saturation <90%), and shorter MH (vertical distance between the lower edge of the mandible and hyoid in the midsagittal plane of computed tomography). Tonsil size and CT90 showed significant predictive value for surgery success (P < .001 for both). CONCLUSION Velopharyngeal surgery was effective in improving nocturnal respiration and excessive daytime sleepiness in patients with OSA at 6-month and 5-year follow-up. Tonsil size and CT90 could be predictors for surgery responders.
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Affiliation(s)
- Guoping Yin
- Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Mu He
- Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xin Cao
- Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Jinkun Xu
- Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yuhuan Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Dan Kang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jingying Ye
- Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
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He M, Yin G, Zhan S, Xu J, Cao X, Li J, Ye J. Long-term Efficacy of Uvulopalatopharyngoplasty among Adult Patients with Obstructive Sleep Apnea: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2019; 161:401-411. [PMID: 31184261 DOI: 10.1177/0194599819840356] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate the long-term efficacy and potential predictors of uvulopalatopharyngoplasty (UPPP) among adult patients with obstructive sleep apnea (OSA). DATA SOURCES A systematic search was conducted through PubMed/Medline, Embase, Web of Science, and the Cochrane Library until December 2018. REVIEW METHODS Full-text articles were selected that studied adult patients who underwent single-level UPPP or its modification for OSA and had a long-term follow-up (at least 34 months) with objective sleep study results. Studies that had no objective outcomes or performed other surgical procedures for OSA were excluded. RESULTS Of 2600 studies, 11 were included. Meta-analysis comparing long-term post- and preoperative outcomes showed significant improvements, with an 15.4 event/h (46.1%) decrease of apnea-hypopnea index. Compared with the short-term outcomes (3-12 months), the long-term outcomes were less effective, with apnea-hypopnea index increasing 12.3 events/h (63.8%) and the surgical response decreasing from 67.3% to 44.35%. Subanalysis of individual patient data showed significant correlations of baseline body mass index, lowest arterial oxygen saturation, and proportion of sleep time with oxygen saturation <90% with long-term surgical response. CONCLUSIONS Despite the surgical efficacy decreasing over time, UPPP and its modification are an effective surgical method for adult OSA in both the short term and the long term after the surgery. Baseline body mass index, lowest arterial oxygen saturation, and proportion of sleep time with oxygen saturation <90% were potentially predictive for long-term surgical response. Case-control studies of the long-term surgical effect of OSA are needed.
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Affiliation(s)
- Mu He
- 1 Department of Otorhinopharyngology-Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Guoping Yin
- 1 Department of Otorhinopharyngology-Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Siyan Zhan
- 2 Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Jinkun Xu
- 1 Department of Otorhinopharyngology-Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xin Cao
- 1 Department of Otorhinopharyngology-Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Jingjing Li
- 1 Department of Otorhinopharyngology-Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Jingying Ye
- 1 Department of Otorhinopharyngology-Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
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Stuck BA, Ravesloot MJL, Eschenhagen T, Sommer JU. Tonsillektomie mit Uvulopalatopharyngoplastik zur Behandlung der obstruktiven Schlafapnoe des Erwachsenen. SOMNOLOGIE 2018. [DOI: 10.1007/s11818-018-0167-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Browaldh N, Bring J, Friberg D. SKUP3
: 6 and 24 months follow-up of changes in respiration and sleepiness after modified UPPP. Laryngoscope 2017; 128:1238-1244. [DOI: 10.1002/lary.26835] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 05/28/2017] [Accepted: 07/06/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Nanna Browaldh
- Division of ENT Diseases; Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet; Stockholm Sweden
- Department of ENT Diseases; Karolinska University Hospital; Stockholm Sweden
| | | | - Danielle Friberg
- Division of ENT Diseases; Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet; Stockholm Sweden
- Department of ENT Diseases; Karolinska University Hospital; Stockholm Sweden
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Choi JH, Cho SH, Kim SN, Suh JD, Cho JH. Predicting Outcomes after Uvulopalatopharyngoplasty for Adult Obstructive Sleep Apnea. Otolaryngol Head Neck Surg 2016; 155:904-913. [DOI: 10.1177/0194599816661481] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 06/01/2016] [Accepted: 07/07/2016] [Indexed: 11/15/2022]
Abstract
Objective Uvulopalatopharyngoplasty (UPPP) remains one of the most common surgical treatments for patients with obstructive sleep apnea. However, the results after UPPP are unpredictable. The purpose of this meta-analysis is to identify predictors of success after UPPP. Data Sources A literature search was performed utilizing PubMed, EMBASE, SCOPUS, and the Cochrane Library. Review Methods The keywords and medical subject heading terms used were uvulopalatopharyngoplasty and UPPP. Studies were included if UPPP was used as a single surgical procedure for the treatment of obstructive sleep apnea and results were presented separately as responder (surgical success) and nonresponder (surgical failure). Exclusion criteria included pediatric patients and other surgical procedures (eg, nasal and hypopharyngeal) performed at the same time as the UPPP. Age, body mass index, preoperative apnea-hypopnea index, Friedman stage, and several cephalometric variables were compared between responders and nonresponders. Results A total of 1257 studies were screened, with 15 studies included in this meta-analysis. Our results demonstrate that Friedman stage I is a strong predictor for success after UPPP, while Friedman stage III and low hyoid position are negative predictors. Age, body mass index, preoperative apnea-hypopnea index, and other cephalometric measurements were not significant. Conclusion Friedman stage and hyoid position are important predictors for UPPP.
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Affiliation(s)
- Ji Ho Choi
- Department of Otorhinolaryngology–Head and Neck Surgery, College of Medicine, Soonchunhyang University, Bucheon Hospital, Bucheon, Korea
| | - Seok Hyun Cho
- Department of Otorhinolaryngology–Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Soo-Nyung Kim
- Department of Obstetrics and Gynecology, College of Medicine, Konkuk University, Seoul, Korea
| | - Jeffrey D. Suh
- Department of Head and Neck Surgery, UCLA School of Medicine, Los Angeles, California, USA
| | - Jae Hoon Cho
- Department of Otorhinolaryngology–Head and Neck Surgery, College of Medicine, Konkuk University, Seoul, Korea
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15
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Extended follow-up of palatal implants for OSA treatment. Otolaryngol Head Neck Surg 2016; 137:822-7. [DOI: 10.1016/j.otohns.2006.12.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2006] [Accepted: 12/19/2006] [Indexed: 11/17/2022]
Abstract
Objective Evaluate long-term safety and outcomes of palatal implants for patients with mild to moderate obstructive sleep apnea (OSA). Study Design and Setting Continuation of a prospective case series of patients with palatal implants. Polysomnography, daytime sleepiness, and snoring intensity were measured at baseline, 90 days, and extended follow-up. Results Twenty-two (42%) patients from the previous study were followed for a median of 435.5 days. Thirteen were classified as responders, based on their 90-day evaluation. 76.9% of initial responders maintained improvements in apnea-hypopnea index (AHI), daytime sleepiness, and snoring at extended follow-up. Nine patients were initial nonresponders for AHI and daytime sleepiness and remained unchanged at extended follow-up. However, snoring for these nine patients initially improved, and the improvement continued through extended follow-up. Conclusion Initial response or nonresponse to palatal implants remains stable over an extended period. The generalizability of these results is unknown because of significant loss to follow-up. Significance Study results report safety and beneficial long-term outcomes of palatal implants for mild to moderate OSA treatment in selected patients.
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Vinogradov OI, Kulagina AM. [Insomnia and sleep-related breathing disturbances are the new risk factors for ischemic stroke]. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:40-47. [PMID: 26120996 DOI: 10.17116/jnevro20151153240-47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sleep disorders have an extremely negative impact on human vital functioning, encompassing both mental and somatic sphere. A large number of clinical trials have shown an increased risk of cardiovascular diseases and their complications, including the risk of ischemic stroke, in patients suffering from insomnia or sleep-related breathing disturbances. These types of sleep disorders are the most common in the structure of all violations of sleep. Obstructive sleep apnea syndrome is the most clinically significant type of sleep-related breathing disturbances. A number of pathophysiological mechanisms that may be responsible for the negative impact of sleep disorders was identified. In order to treat insomnia, behavioral techniques, including the normalization of sleep hygiene, behavioral and cognitive therapy, medication treatment, are used. Continuous Positive Airway Pressure (CPAP) therapy is currently the method of choice in the treatment of obstructive sleep apnea syndrome of any etiology.
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Affiliation(s)
| | - A M Kulagina
- Pirogov National Center of Therapy and Surgery, Moscow
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Tan KB, Toh ST, Guilleminault C, Holty JEC. A Cost-Effectiveness Analysis of Surgery for Middle-Aged Men with Severe Obstructive Sleep Apnea Intolerant of CPAP. J Clin Sleep Med 2015; 11:525-35. [PMID: 25700871 PMCID: PMC4410926 DOI: 10.5664/jcsm.4696] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 12/09/2014] [Indexed: 12/11/2022]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is associated with increased cardiovascular morbidity and mortality. Conventional OSA therapy necessitates indefinite continuous positive airway pressure (CPAP). Although CPAP is an effective treatment modality, up to 50% of OSA patients are intolerant of CPAP. We explore whether surgical modalities developed for those intolerant of CPAP are cost-effective. METHODS We construct a lifetime semi-Markov model of OSA that accounts for observed increased risks of stroke, cardiovascular disease, and motor vehicle collisions for a 50-year-old male with untreated severe OSA. Using this model, we compare the cost-effectiveness of (1) no treatment, (2) CPAP only, and (3) CPAP followed by surgery (either palatopharyngeal reconstructive surgery [PPRS] or multilevel surgery [MLS]) for those intolerant to CPAP. RESULTS Compared with the CPAP only strategy, CPAP followed by PPRS (CPAP-PPRS) adds 0.265 quality adjusted life years (QALYs) for an increase of $2,767 (discounted 2010 dollars) and is highly cost effective with an incremental cost-effectiveness ratio (ICER) of $10,421/QALY for a 50-year-old male with severe OSA. Compared to a CPAP-PPRS strategy, the CPAP-MLS strategy adds 0.07 QALYs at an increase of $6,213 for an ICER of $84,199/QALY. The CPAP-PPRS strategy appears cost-effective over a wide range of parameter estimates. CONCLUSIONS Palatopharyngeal reconstructive surgery appears cost-effective in middle-aged men with severe OSA intolerant of CPAP. Further research is warranted to better define surgical candidacy as well as short-term and long-term surgical outcomes. COMMENTARY A commentary on this article appears in this issue on page 509.
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Affiliation(s)
- Kelvin B. Tan
- Stanford University, Management Science and Engineering Department, Stanford, CA
- Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA
| | | | | | - Jon-Erik C. Holty
- Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA
- Pulmonary, Critical Care and Sleep Section, VA Palo Alto Healthcare System, Palo Alto, CA
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Olfactory loss after uvulopalatopharyngoplasty: a report of two cases with review of the literature. Case Rep Otolaryngol 2015; 2014:546317. [PMID: 25610685 PMCID: PMC4294296 DOI: 10.1155/2014/546317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 12/18/2014] [Accepted: 12/18/2014] [Indexed: 11/18/2022] Open
Abstract
Uvulopalatopharyngoplasty (UPPP) has been a popular surgical method for treating obstructive sleep apnea syndrome since it was introduced in the early 1980s. Olfactory loss has been reported as a rare side effect in several cases. However, the olfactory test results and the prognosis were not mentioned in these cases. We present two patients who complained of loss of olfactory function after UPPP. Their olfactory function was evaluated by the phenyl ethyl alcohol odor detection threshold test and the University of Pennsylvania Smell Identification Test. After treatment with steroid and zinc salt, their olfactory function was improved but not recovered completely.
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Vidigal TA, Haddad FLM, Cabral RFP, Oliveira MCS, Cavalcante RR, Bittencourt LRA, Tufik S, Gregório LC. New clinical staging for pharyngeal surgery in obstructive sleep apnea patients. Braz J Otorhinolaryngol 2014; 80:490-6. [PMID: 25457068 PMCID: PMC9442696 DOI: 10.1016/j.bjorl.2014.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 08/01/2014] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION The success of pharyngeal surgery in the treatment of obstructive sleep apnea syndrome depends on the appropriate selection of patients. OBJECTIVE To propose a new staging for indication of pharyngeal surgery in obstructive sleep apnea syndrome. METHODS A total of 54 patients undergoing extended tonsillectomy were retrospectively included, divided into six stages. Stage I: patients with palatine tonsils grade 3/4 and modified Mallampati index 1/2; stage II: palatine tonsils 3/4 and modified Mallampati index 3/4; stage III: palatine tonsils 1/2 and modified Mallampati index 1/2; stage IV: palatine tonsils 1/2 and modified Mallampati index 3/4; stage V: body mass index ≥40 kg/m(2) with palatine tonsils 3/4 and modified Mallampati index 1, 2, 3, or 4. Stage VI: body mass index ≥40 with palatine tonsils 1/2 and modified Mallampati index 1, 2, 3, or 4. RESULTS The surgical success rates were 88.9%, 75.0%, 35.7%, 38.5%, and 100.0% in stages I-V. CONCLUSION The presence of hypertrophic palatine tonsils was the anatomical factor in common in the most successful stages (I, II, and V), regardless of body mass index. Although the modified Mallampati index classes 3 and 4 reduced the success rate of surgery in patients with hypertrophic tonsils (stage II), the presence of modified Mallampati index classes 1 and 2 did not favor surgical success in patients with normal tonsils (stage III).
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Affiliation(s)
- Tatiana Aguiar Vidigal
- Department of Otorhinolaryngology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Fernanda Louise Martinho Haddad
- Department of Otorhinolaryngology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
| | | | | | | | - Lia Rita Azeredo Bittencourt
- Department of Otorhinolaryngology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Sergio Tufik
- Department of Otorhinolaryngology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Luis Carlos Gregório
- Department of Otorhinolaryngology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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Zhang J, Li Y, Cao X, Xian J, Tan J, Dong J, Ye J. The combination of anatomy and physiology in predicting the outcomes of velopharyngeal surgery. Laryngoscope 2013; 124:1718-23. [DOI: 10.1002/lary.24510] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 09/25/2013] [Accepted: 11/04/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Junbo Zhang
- Department of OtolaryngologyHead and Neck SurgeryBeijing China
| | - Yanru Li
- Department of OtolaryngologyHead and Neck SurgeryBeijing China
| | - Xin Cao
- Department of OtolaryngologyHead and Neck SurgeryBeijing China
| | - Junfang Xian
- Department of Radiology, Beijing Tongren HospitalCapital Medical UniversityBeijing China
| | - Junlong Tan
- Department of OtolaryngologyHead and Neck SurgeryBeijing China
| | - Jiajia Dong
- Department of OtolaryngologyHead and Neck SurgeryBeijing China
| | - Jingying Ye
- Department of OtolaryngologyHead and Neck SurgeryBeijing China
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Braga A, Grechi TH, Eckeli A, Vieira BB, Itikawa CE, Küpper DS, Matsumoto MA, Trawitzki LV, Felício CM, Fernandes RM, Valera FC. Predictors of uvulopalatopharyngoplasty success in the treatment of obstructive sleep apnea syndrome. Sleep Med 2013; 14:1266-71. [DOI: 10.1016/j.sleep.2013.08.777] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 07/21/2013] [Accepted: 08/04/2013] [Indexed: 11/28/2022]
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Ivanoff CS, Hottel TL, Pancratz F. Is There a Place for Teaching Obstructive Sleep Apnea and Snoring in the Predoctoral Dental Curriculum? J Dent Educ 2012. [DOI: 10.1002/j.0022-0337.2012.76.12.tb05427.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Chris S. Ivanoff
- Department of Prosthodontics; College of Dentistry; University of Tennessee Health Science Center
| | - Timothy L. Hottel
- Department of Prosthodontics; University of Tennessee Health Science Center
| | - Frank Pancratz
- College of Dentistry; University of Tennessee Health Science Center
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Braga A, Carboni LH, do Lago T, Küpper DS, Eckeli A, Valera FCP. Is uvulopalatopharyngoplasty still an option for the treatment of obstructive sleep apnea? Eur Arch Otorhinolaryngol 2012; 270:549-54. [DOI: 10.1007/s00405-012-2042-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 04/24/2012] [Indexed: 11/30/2022]
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Tanyeri H, Polat S, Kirişoğlu CE, Serin GM. Long-term efficacy of submucosal uvulopalatopharyngoplasty for obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol 2012; 269:2069-74. [DOI: 10.1007/s00405-011-1919-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 12/29/2011] [Indexed: 10/14/2022]
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Browaldh N, Friberg D, Svanborg E, Nerfeldt P. 15-year efficacy of uvulopalatopharyngoplasty based on objective and subjective data. Acta Otolaryngol 2011; 131:1303-10. [PMID: 22074106 DOI: 10.3109/00016489.2011.616912] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS This follow-up showed a stable and significant decrease in median oxygen desaturation index 4% (ODI(4)) values over the years. Approximately two-thirds of the patients fulfilled the success criteria (ODI(4) reduction of 50% and <20) after 15 years. A majority had improved/cured excessive daytime sleepiness (EDS) and were satisfied. No increased mortality rate was seen. OBJECTIVES To evaluate sleep apnoea recordings and symptoms in patients with obstructive sleep apnoea syndrome 15 years after uvulopalatopharyngoplasty (UPPP) compared to baseline and previous follow-ups. METHODS This was a non-randomized, prospective intervention study on 50 patients who underwent UPPP during 1985-88. Their initial median age was 49 years (range 38-71) and ODI(4) was 26.5 (4-82). RESULTS In all, 13 patients had died; 26 patients underwent sleep apnoea recordings. Median ODI(4) had decreased from 26.5 (range 4-82) to 8.5 (0-60), p < 0.01, a mean reduction of 52%; 65% of patients achieved the success criteria. One-third was objectively categorized as non-snorers. Median body mass index was unchanged. The questionnaires were answered by 32 of 37 patients; 88% reported improved or cured EDS and 78% were satisfied. Pharyngeal disturbances ratings were low. The standardized mortality rate did not differ from the general Swedish population.
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Affiliation(s)
- Nanna Browaldh
- Department of Otorhinolaryngology, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
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Neruntarat C. Uvulopalatal flap for obstructive sleep apnea: Short-term and long-term results. Laryngoscope 2011; 121:683-7. [DOI: 10.1002/lary.21157] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2010] [Accepted: 07/22/2010] [Indexed: 11/07/2022]
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The effect of uvula-preserving palatopharyngoplasty in obstructive sleep apnea on globus sense and positional dependency. Clin Exp Otorhinolaryngol 2010; 3:141-6. [PMID: 20978544 PMCID: PMC2958507 DOI: 10.3342/ceo.2010.3.3.141] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2010] [Accepted: 06/14/2010] [Indexed: 12/02/2022] Open
Abstract
Objectives This study investigated the outcomes of uvula-preserving palatopharyngoplasty (UPPPP) in patients with obstructive sleep apnea syndrome (OSAS). Methods Twenty men with obstructive sleep apnea syndrome received the UPPPP operation at our institution. We measured symptom changes after UPPPP using a visual analog scale (VAS), and all patients were examined with polysomnography pre- and post-operatively. 'Surgical success' was defined as reduction in apnea-hypopnea index (AHI) to below 20 events per hour and more than 50% post-operative reduction. Results Snoring decreased significantly (6.7±2.3 to 3.7±2.9 on VAS, P=0.002) but the postoperative globus sense did not differ from that preoperatively (2.0±2.4 to 2.1±2.7 on VAS, P=0.79). Apnea and apnea-hypopnea indices were significantly reduced after UPPPP (34.7±20 to 24.2±17.2 events/hour, P=0.029). The surgical success rate was 40% regardless of Friedman stage. There was significant reduction in the AHI on supine sleep in both surgically successful and unsuccessful patient groups. Conclusion UPPPP may minimize postoperative globus sense and other complications, with a success rate comparable to that of previously reported surgical methods in OSAS patients. In addition, it may reduce the apnea-hypopnea index in the supine sleep position.
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Halme P, Toskala E, Laurikainen E, Antila J, Tsushima Y, Polo O. LUPP relieves partial upper airway obstruction during sleep in patients with velopharyngeal narrowing. Acta Otolaryngol 2010; 130:614-9. [PMID: 19968607 DOI: 10.3109/00016480903311872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Patients with upper airway narrowing at the soft palate level and partial upper airway obstruction during sleep seem to benefit from laser-assisted uvulopalatoplasty (LUPP) in terms of decreased velopharyngeal collapsibility and improved nocturnal breathing. OBJECTIVES The current operative treatments for obstructive sleep apnea syndrome (OSAS) are not very effective compared with continuous positive airway pressure (CPAP). It has been suggested that active treatment should be performed earlier, when sleep apnea is present in a milder form. The main problem is identifying progressive sleep apnea. The present study assessed the efficacy of LUPP in patients with partial upper airway obstruction during sleep diagnosed by means of a static charge-sensitive bed (SCSB) combined with oxyhemoglobin desaturation recording and digital fluoroscopy-based collapsibility estimation. METHODS LUPP was carried out in 27 patients under local anesthesia as day surgery. Digital fluoroscopy and SCSB were recorded preoperatively and 6 months after LUPP. RESULTS Partial upper airway obstruction events and arterial oxyhemoglobin desaturations during sleep decreased significantly. Digital fluoroscopy revealed that the minimal anteroposterior dimension increased and collapsibility decreased at the level where velopharyngeal obstruction occurred, the soft palate.
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Affiliation(s)
- Perttu Halme
- Department of Otorhinolaryngology-Head and Neck Surgery, Turku University Hospital, Turku, Finland.
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Abstract
The current guideline discusses conservative and surgical therapy of obstructive sleep apnea (OSA) in adults from the perspective of the ear, nose and throat specialist. The revised guideline was commissioned by the German Society of Ear-Nose-Throat, Head-Neck Surgery (DG HNO KHC) and compiled by the DG HNO KHC's Working Group on Sleep Medicine. The guideline was based on a formal consensus procedure according to the guidelines set out by the German Association of Scientific Medical Societies (AWMF) in the form of a"S2e guideline". Research of the literature available on the subject up to and including December 2008 forms the basis for the recommendations. Evaluation of the publications found was made according to the recommendations of the Oxford Centre for Evidence-Based Medicine (OCEBM). This yielded a recommendation grade, whereby grade A represents highly evidence-based studies and grade D those with a low evidence base.
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Khan A, Ramar K, Maddirala S, Friedman O, Pallanch JF, Olson EJ. Uvulopalatopharyngoplasty in the management of obstructive sleep apnea: the mayo clinic experience. Mayo Clin Proc 2009; 84:795-800. [PMID: 19720777 PMCID: PMC2735429 DOI: 10.1016/s0025-6196(11)60489-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the role of uvulopalatopharyngoplasty (UPPP) in the treatment of obstructive sleep apnea (OSA) using polysomnography (PSG) data within 6 months before and after surgery. PATIENTS AND METHODS We analyzed PSG and body mass index (BMI) data from patients with OSA who were 18 years or older and who underwent UPPP between January 1, 1988, and August 31, 2006. RESULTS Sixty-three patients (51 men [81.0%]; mean +/- SD age, 42.1+/-13.9 years; mean +/- SD BMI, 34.9+/-7.2) underwent PSG a mean +/- SD of 50+/-47 days before and 88.5+/-34.0 days after UPPP. Surgical cure was defined as a postoperative apnea-hypopnea index (AHI) of 5 or less. Fifteen patients (24%) achieved a surgical cure. Twenty-one patients (33%) had a postoperative AHI of 10 or less, whereas 32 (51%) achieved a 50% or greater reduction in AHI and/or an AHI of 20 or less. No significant changes were noted in BMI before and 6 months after UPPP. Patients who attained an AHI of 5 or less were younger (mean +/- SD age, 35.9+/-13.1 vs 44+/-13.7 years; P=.05), had lower BMIs (mean +/- SD, 30.8+/-6.5 vs 34.6+/-6.6; P=.05), and had less severe OSA (mean +/- SD AHI, 38.1+/-33.6 vs 69.6+/-32.8; P=.004). Of the 48 patients (76%) with a post-UPPP AHI greater than 5, 35 (56%) received continuous positive airway pressure, with a mean reduction in pressure of 1.4 cm H(2)O (95% confidence interval, -0.4 to -2.4 cm H(2)O). CONCLUSION Independent of changes in BMI, in our retrospective analysis, UPPP achieved an AHI of 5 or less in 24% and an AHI of 10 or less in 33% of patients with OSA who underwent PSG 6 months before and after surgery. In those with residual OSA who received continuous positive airway pressure, the required pressure setting decreased by 1.4 cm H(2)O.
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Affiliation(s)
- Akram Khan
- Division of Pulmonary, Critical Care, and Sleep Medicine, Center for Sleep Medicine, Oregon Health & Science University, Portland, OR 97239-3098, USA.
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Khan A, Ramar K, Maddirala S, Friedman O, Pallanch JF, Olson EJ. Uvulopalatopharyngoplasty in the management of obstructive sleep apnea: the mayo clinic experience. Mayo Clin Proc 2009; 84:795-800. [PMID: 19720777 PMCID: PMC2735429 DOI: 10.4065/84.9.795] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
OBJECTIVE To assess the role of uvulopalatopharyngoplasty (UPPP) in the treatment of obstructive sleep apnea (OSA) using polysomnography (PSG) data within 6 months before and after surgery. PATIENTS AND METHODS We analyzed PSG and body mass index (BMI) data from patients with OSA who were 18 years or older and who underwent UPPP between January 1, 1988, and August 31, 2006. RESULTS Sixty-three patients (51 men [81.0%]; mean +/- SD age, 42.1+/-13.9 years; mean +/- SD BMI, 34.9+/-7.2) underwent PSG a mean +/- SD of 50+/-47 days before and 88.5+/-34.0 days after UPPP. Surgical cure was defined as a postoperative apnea-hypopnea index (AHI) of 5 or less. Fifteen patients (24%) achieved a surgical cure. Twenty-one patients (33%) had a postoperative AHI of 10 or less, whereas 32 (51%) achieved a 50% or greater reduction in AHI and/or an AHI of 20 or less. No significant changes were noted in BMI before and 6 months after UPPP. Patients who attained an AHI of 5 or less were younger (mean +/- SD age, 35.9+/-13.1 vs 44+/-13.7 years; P=.05), had lower BMIs (mean +/- SD, 30.8+/-6.5 vs 34.6+/-6.6; P=.05), and had less severe OSA (mean +/- SD AHI, 38.1+/-33.6 vs 69.6+/-32.8; P=.004). Of the 48 patients (76%) with a post-UPPP AHI greater than 5, 35 (56%) received continuous positive airway pressure, with a mean reduction in pressure of 1.4 cm H(2)O (95% confidence interval, -0.4 to -2.4 cm H(2)O). CONCLUSION Independent of changes in BMI, in our retrospective analysis, UPPP achieved an AHI of 5 or less in 24% and an AHI of 10 or less in 33% of patients with OSA who underwent PSG 6 months before and after surgery. In those with residual OSA who received continuous positive airway pressure, the required pressure setting decreased by 1.4 cm H(2)O.
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Affiliation(s)
- Akram Khan
- Division of Pulmonary, Critical Care, and Sleep Medicine, Center for Sleep Medicine, Oregon Health & Science University, Portland, OR 97239-3098, USA.
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Lee CH, Shin HW, Han DH, Mo JH, Yoon IY, Chung S, Choi HG, Kim JW. The implication of sleep position in the evaluation of surgical outcomes in obstructive sleep apnea. Otolaryngol Head Neck Surg 2009; 140:531-5. [PMID: 19328342 DOI: 10.1016/j.otohns.2008.12.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Revised: 11/12/2008] [Accepted: 12/09/2008] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the effect of sleep position on surgical outcomes in obstructive sleep apnea (OSA). STUDY DESIGN Retrospective review of 69 consecutive patients. SUBJECTS AND METHODS Preoperative and postoperative polysomnographic data and Epworth sleepiness scale were obtained. Patients were categorized into success, response, no response, and failure groups according to apnea-hypopnea index (AHI) after uvulopalatopharyngoplasty. Proportions of supine or lateral position and AHI of each position were evaluated. Position-corrected AHI was developed in order to eliminate the effect of sleep position. RESULTS Preoperative proportion of supine position in the failure group (n = 26) was 41.3 percent, which was the lowest among four groups (P = 0.010), and increased to 60.8 percent postoperatively (P = 0.028). Twenty-two (84.6%) among the failure group had supine position dependency. Regrouped by position-corrected AHI, 15 patients moved into different groups. Postoperative AHI showed positive correlation with increased supine position when BMI was controlled (r = 0.515, P = 0.006). CONCLUSION Without appropriate correction based on the change of sleep position, the fluctuation of sleep position in each polysomnography might confound surgical outcomes in OSA patients. Thus, it is a substantial issue how to control or reflect the positional effect on AHI when treatment results are evaluated.
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Affiliation(s)
- Chul Hee Lee
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang-Gu, Seongnam, Korea
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Long-term effects of radiofrequency ablation of the soft palate on snoring. Eur Arch Otorhinolaryngol 2009; 267:137-42. [DOI: 10.1007/s00405-009-0979-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Accepted: 03/30/2009] [Indexed: 10/20/2022]
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Abstract
One of the most common yet unidentified conditions in heart disease is sleep-disordered breathing (SDB). Although it is most prevalent in patients with heart failure, it has been epidemiologically and pathophysiologically linked to ischemic heart disease, hypertension, sudden cardiac death, atrial fibrillation, and stroke. There are two primary SDB syndromes: obstructive sleep apnea (OSA) and central sleep apnea (CSA; also known as Cheyne-Stokes respiration). The pathophysiologic mechanisms that underlie these disorders appear to be distinct but both involve recurrent cycles of excessive sympathetic activation, hypoxemias and hypercapnias, and increases in ventricular wall stress. Signs and symptoms may include daytime somnolence, snoring, difficult-to-control hypertension, and refractory arrhythmias or angina. In heart failure, half of patients will have SDB and most patients will exhibit evidence of both OSA and CSA, although one or the other may predominate. The current standard diagnostic method is overnight laboratory polysomnography. Primary therapies for OSA include lifestyle changes, various facial and oral appliances, head and neck surgery, and continuous positive airway pressure (CPAP). CPAP is the most effective form of therapy for OSA, with few side effects, but is limited by compliance because of comfort-related issues. In patients with cardiovascular disease who predominantly suffer from OSA, treatment recommendations should be based on current guidelines for OSA. For patients with heart failure with predominant CSA, the current cornerstone of therapy is the optimization of medical therapy and resynchronization therapy when indicated. When SDB persists despite optimal medical management, referral to a sleep medicine consultant should be considered.
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Strauss RA. Lasers in the management of snoring and mild sleep apnea. Oral Maxillofac Surg Clin North Am 2007; 14:319-31. [PMID: 18088634 DOI: 10.1016/s1042-3699(02)00027-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Robert A Strauss
- Residency Training Program, Department of Oral and Maxillofacial Surgery, Virginia Commonwealth University / Medical College of Virginia, Richmond, VA 23298, USA.
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Strauss RA. Lasers in the management of snoring and mild sleep apnea. Oral Maxillofac Surg Clin North Am 2007; 16:255-67. [PMID: 18088728 DOI: 10.1016/j.coms.2004.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Robert A Strauss
- Department of Oral and Maxillofacial Surgery, Virginia Commonwealth University Medical Center, P.O. Box 980566, Richmond, VA 23298, USA
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O’Connor-Reina C, Garcia-Iriarte MT, Casado-Morente JC, Gomez-Angel D, Rodriguez-Diaz A, Plaza-Mayor G. Snoring surgery with palatal implants after failed uvulopalatopharyngoplasty. Eur Arch Otorhinolaryngol 2007; 265:687-93. [DOI: 10.1007/s00405-007-0525-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2007] [Accepted: 10/29/2007] [Indexed: 10/22/2022]
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Hsu PP, Tan AKL, Tan BYB, Gan EC, Chan YH, Blair RL, Lu PKS. Uvulopalatopharyngoplasty outcome assessment with quantitative computer-assisted videoendoscopic airway analysis. Acta Otolaryngol 2007; 127:65-70. [PMID: 17364332 DOI: 10.1080/00016480600672659] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
CONCLUSION Quantitative digital imaging upper airway analysis enables surgeons to assess the pre- and postoperative upper airway morphology quantitatively, objectively and accurately, and to correlate these changes in surgical parameters with improvement of obstructive sleep apnea. OBJECTIVE This was a prospective study using a new method of quantitative computer-assisted digital-imaging videoendoscopic upper airway analysis to quantify objectively and correlate the changes in surgical parameters with improvement of obstructive sleep apnea following uvulopalatopharyngoplasty. PATIENTS AND METHODS Nineteen male patients underwent uvulopalatopharyngoplasty for obstructive sleep apnea after continuous positive airway pressure trial. All had undergone pre- and postoperative digital imaging upper airway examination, Epworth scores, and polysomnographic studies. Postoperative static and dynamic changes in upper airway parameters were compared, analyzed and correlated with improvement of the apnea-hypopnea index (AHI) by statistical regression. RESULTS There were 65.12% and 64.37% improvements in the AHI and Epworth scales, respectively, after uvulopalatopharyngoplasty. Retropalatal areas measured were significantly correlated with improvement of the AHI. A 1 cm2 increase in retropalatal area during Mueller's maneuver in the supine position resulted in an improvement of 32.65 in the AHI; a 1 cm increase in the transverse diameter of the retropalatal area in the erect position resulted in an improvement of 31.83 in the AHI.
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Affiliation(s)
- Pon Poh Hsu
- Division of Otolaryngology, Changi General Hospital, Singapore, Republic of Singapore
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Kinoshita H, Shibano A, Sakoda T, Ikeda H, Iranami H, Hatano Y, Enomoto T. Uvulopalatopharyngoplasty decreases levels of C-reactive protein in patients with obstructive sleep apnea syndrome. Am Heart J 2006; 152:692.e1-5. [PMID: 16996837 DOI: 10.1016/j.ahj.2006.07.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2006] [Accepted: 07/06/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND C-reactive protein is a crucial risk factor for cardiovascular diseases. Previous studies demonstrated that in patients with obstructive sleep apnea syndrome (OSAS), levels of this protein elevate dependently on the degree of upper airway obstruction. However, it has not been determined whether the surgery for OSAS reduces the levels of C-reactive protein by restoring the airway opening. Therefore, we evaluated the effect of uvulopalatopharyngoplasty (UPPP) on levels of serum C-reactive protein in patients with this syndrome. METHODS Fifteen adult patients with mild to severe OSAS were enrolled in this study. Levels of serum C-reactive protein and sleep parameters including apnea-hypopnea index a month before and 3 months after UPPP were evaluated using peripheral venous blood and polysomnography, respectively. RESULTS Uvulopalatopharyngoplasty significantly restored sleep parameters, accompanying with decreased levels of C-reactive protein (from 0.21 +/- 0.17 to 0.10 +/- 0.16 mg/dL, P < .05). CONCLUSIONS In patients with OSAS, UPPP appears to decrease levels of serum C-reactive protein. Surgical therapy may reduce inflammatory response in these patients.
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Affiliation(s)
- Hiroyuki Kinoshita
- Department of Anesthesiology, Japanese Red Cross Society Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama, Wakayama 640-8269, Japan.
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Martinho FL, Zonato AI, Bittencourt LRA, Soares MCM, Silva RFN, Gregório LC, Tufik S. Obese obstructive sleep apnea patients with tonsil hypertrophy submitted to tonsillectomy. Braz J Med Biol Res 2006; 39:1137-42. [PMID: 16906289 DOI: 10.1590/s0100-879x2006000800017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2005] [Accepted: 03/30/2006] [Indexed: 11/21/2022] Open
Abstract
The physiopathology of obstructive sleep apnea-hypopnea syndrome (OSAHS) is multifactorial and obesity has been shown to be one of the main factors correlated with its occurrence. In obese patients with anatomical alterations of the upper airways it is often difficult to predict success for surgical correction since obesity is a limiting factor. Therefore, the aim of the present study was to evaluate the results of tonsillectomy in a specific group of patients, i.e., obese OSAHS patients with tonsil hypertrophy. Seven OSAHS patients with moderate obesity with obstructive palatine tonsil hypertrophy were submitted to tonsillectomy. All patients were submitted to pre- and postoperative appraisal of body mass index, otorhinolaryngology examination and polysomnography. Patients' average age was 36.4 +/- 10.3 years and average preoperative body mass index was 36.6 +/- 6.3 kg/m(2). Postoperative weight did not differ significantly from preoperative weight (P = 0.27). Average preoperative apnea and hypopnea index (AHI) was 81 +/- 26/h and postoperative AHI was 23 +/- 18/h (P = 0.0005). Average preoperative minimum oxyhemoglobin saturation (SaO2 min) was 69 +/- 14% and the postoperative value was 83 +/- 3% (P = 0.038). In relation to AHI, 6 (86%) of the 7 patients studied showed a reduction of 50% in relation to preoperative level and of these, 4 (57%) presented AHI of less than 20%. Only one patient presented a reduction of less than 50% in AHI, but even so showed improved SaO2 min. Tonsillectomy treatment for OSAHS in obese patients with obstructive palatine tonsil hypertrophy caused a significant reduction in AHI, with improvement in SaO2 min. This procedure could be eventually considered as an option of treatment for obese OSAHS patients with significant tonsil hypertrophy when continuous positive air pressure therapy is not possible as the first choice of treatment.
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Affiliation(s)
- F L Martinho
- Departamento de Otorrinolaringologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil.
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Randerath W, Bauer M, Blau A, Fietze I, Galetke W, Hein H, Maurer JT, Orth M, Rasche K, Ruhle KH, Sanner B, Stuck BA, Verse T. Stellenwert der Nicht-nCPAP-Verfahren in der Therapie des obstruktiven Schlafapnoe-Syndroms. Relevance of Non-CPAP Treatment Options in the Therapy of the Obstructive Sleep Apnoea Syndrome. SOMNOLOGIE 2006. [DOI: 10.1111/j.1439-054x.2006.00082.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Stellenwert der Nicht-nCPAP-Verfahren in der Therapie des obstruktiven Schlafapnoe-Syndroms. SOMNOLOGIE 2006. [DOI: 10.1007/j.1439-054x.2006.00082.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Sleep-related breathing disorders and restless legs syndrome have traditionally been felt to affect primarily adults. Recent research suggests that these conditions are surprisingly common in children as well, and that clinical manifestations may differ considerably from those seen in adults. This review summarizes the clinical characteristics, epidemiology, pathophysiology, and treatment of sleep-related breathing disorders and restless legs syndrome in children. Particular emphasis is placed on recent research and on how the presentation and treatment of these conditions are different in children compared with adults.
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Affiliation(s)
- Timothy F Hoban
- Department of Pediatrics, The Michael S. Aldrich Sleep Disorders Center, University of Michigan, Ann Arbor, MI 48109-0203, USA.
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Hultcrantz E, Linder A, Markström A. Long-term effects of intracapsular partial tonsillectomy (tonsillotomy) compared with full tonsillectomy. Int J Pediatr Otorhinolaryngol 2005; 69:463-9. [PMID: 15763282 DOI: 10.1016/j.ijporl.2004.11.010] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2004] [Revised: 10/23/2004] [Accepted: 11/08/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To compare the long-term effects (six years after surgery) of two techniques for pediatric tonsil surgery with respect to snoring, apneas, eating difficulties, infections and general health. The two methods were intracapsular partial tonsillectomy (tonsillotomy, "TT") using CO(2)-laser technique and traditional (total) blunt dissection tonsillectomy (TE). STUDY DESIGN A questionnaire distributed by mail to the parents of children, who, in 1998, were included in a prospective clinical randomized study in one tertiary care ENT clinic. METHOD A 10 question survey follow-up of 41 children, between 9 and 15 years of age, who originally, six years earlier had been randomized to either TT with CO(2)-laser (n=21) or TE (n=20). The main indication for the surgery was a history of sleep related breathing distress (SRBD). Before the present study, all of the children had participated in earlier follow-ups at six months and one year after surgery. RESULTS All the children in both groups answered the questionnaire. There were no significant differences between the answers from the two groups in any respects: the effect on snoring and apneas was equally stable for both groups. The number of children who remained free from snoring decreased from 40 after the first year to 25 after six years (11 TT, 14 TE). Snoring in the recurrent cases was not rated to be as frequent or as loud as before the surgery. Infections of the upper respiratory tract (URI) that had been treated with antibiotics occurred to the same extent in both groups. None had eating difficulties. The patients' satisfaction with the results of the surgery was high or very high in 18/21 TT and 20 TE cases, and the vast majority of the parents rated their children's present health status as improved compared with the preoperative condition. CONCLUSION Tonsillotomy with CO(2)-laser seems to be a reliable method for tonsil surgery with substantially less primary morbidity than conventional tonsillectomy and with the same positive long-term effects after six years.
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Affiliation(s)
- Elisabeth Hultcrantz
- Department of Neuroscience and Locomotion, Division of Otorhinolaryngology, Linköping University, SE-58185 Linköping, Sweden.
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Hoekema A, Stegenga B, De Bont LGM. Efficacy and co-morbidity of oral appliances in the treatment of obstructive sleep apnea-hypopnea: a systematic review. ACTA ACUST UNITED AC 2004; 15:137-55. [PMID: 15187032 DOI: 10.1177/154411130401500303] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) is a common sleep-related breathing disorder characterized by repetitive obstructions of the upper airway during sleep. Modification of pharyngeal patency by Oral Appliance (OA) therapy has been suggested as an alternative to various treatment modalities for OSAHS. To determine the evidence base with respect to the efficacy and co-morbidity of OA therapy in OSAHS, we conducted a systematic review of the available literature. Primary outcome measures were the reduction in number of upper-airway obstructions and co-morbidity related to the craniomandibular or craniofacial complex, respectively. Eligible studies regarding efficacy were independently assessed by two assessors using a quality assessment scale. Effect sizes of methodologically sound studies were calculated. In identical interventions, effect sizes were pooled with the use of a random-effects model. Given the scarcity of controlled studies related to co-morbidity, appraisal was confined to a description of eligible studies. Sixteen controlled trials related to efficacy were identified. With respect to the primary outcome measure, OA therapy was clearly more effective than control therapy (pooled effect size, -0.96; 95% confidence interval [CI], -1.49 to -0.42) and possibly more effective than uvulopalatopharyngoplasty. Although patients generally preferred OA therapy, improvement of respiratory variables, such as the number of upper-airway obstructions, was usually better in Continuous Positive Airway Pressure (CPAP) therapy (pooled effect size, 0.83; 95% CI, 0.59 to 1.06). Moreover, specific aspects related to OA design may influence patient-perceived efficacy and preference. Twelve patient-series and one controlled trial related to co-morbidity were identified. Analysis of the data suggests that OA therapy may have adverse effects on the craniomandibular and craniofacial complex. Although CPAP is apparently more effective and adverse effects of OA treatment have been described, it can be concluded that OA therapy is a viable treatment for, especially, mild to moderate OSAHS. Controlled studies addressing the specific indication and co-morbidity of OA therapy are warranted.
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Affiliation(s)
- A Hoekema
- Department of Oral and Maxillofacial Surgery and Maxillofacial Prosthetics, Groningen University Hospital, 9700 RB Groningen, the Netherlands.
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Vanderveken OM, Boudewyns AN, Braem MJ, Okkerse W, Verbraecken JA, Willemen M, Wuyts FL, De Backer WA, Van de Heyning PH. Pilot study of a novel mandibular advancement device for the control of snoring. Acta Otolaryngol 2004; 124:628-33. [PMID: 15267184 DOI: 10.1080/00016480310015984] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Mandibular advancement devices (MADs) have been introduced as a conservative, non-invasive treatment for socially disturbing snoring and mild obstructive sleep apnea (OSA). A prospective, non-randomized pilot study was conducted to investigate the efficacy, feasibility, side-effects and compliance of Somnoguard, an immediately intraorally adaptable MAD made from thermoplastic material. MATERIAL AND METHODS Twenty consecutive heavy snorers with a respiratory disturbance index of <20 events/h were prospectively selected. Prior to the adaptation of the appliance, ambulatory polygraphy was carried out without a MAD. After a 1-month habituation period, a polygraphic evaluation was carried out with the device. Treatment success was defined as a reduction in the apnea-hypopnea index (AHI) of at least 50%. RESULTS The results indicated a success rate of 65%. The AHI decreased from 8.4 +/- 2.9 events/h at baseline to 3.9 +/- 1.8 events/h with the device (p = 0.001). At 1-month follow-up, significant reductions in the snoring index (p < 0.001) and the Epworth Sleepiness Scale (ESS) score (p = 0.036) were noted. At 6-month follow-up, similar results were achieved, with significant drops in the snoring index (p = 0.025) and ESS score (p = 0.033). CONCLUSION We conclude that immediate intraoral adaptation of a low-cost fabricated "one-size-only" MAD is a feasible and well-tolerated treatment for snoring and mild OSA. Further research is needed to evaluate this thermoplastic appliance as a strategy to "screen" the efficacy of MAD treatment in the individual patient with a less expensive appliance before constructing a more expensive custom-made MAD.
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Affiliation(s)
- Olivier M Vanderveken
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, University of Antwerp, Antwerp, Belgium.
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Abstract
Obstructive sleep apnoea is characterised by repetitive interruptions of breathing during sleep due to upper airway collapse. It affects sleep quality, daytime alertness and quality of life. It is associated with increased cardiovascular morbidity and mortality and an increased risk of road traffic accidents. Sleep apnoea is common among older people and its effects can be more severe than in younger people. The added impact is because of a physiological decline in sleep quality with age in most people and the increasing frequency of other comorbidities with increasing years that affect both sleep and daytime function. It is important to be alert to the diagnosis, bearing in mind these other influences on sleep quality. The diagnosis is generally straightforward once appropriate tests are performed. Treatment is aimed at minimising upper airway obstruction during sleep and the most effective therapy is continuous positive airway pressure. Weight loss can also be effective. Other management options, including surgery, mandibular advancement devices and drug treatment, are less effective, but there are interesting advances in the understanding of the pharmacology of the upper airway. Specific serotonergic agonists hold the greatest potential for a useful drug treatment for this widespread and debilitating condition.
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Affiliation(s)
- Timothy G Quinnell
- Respiratory Support and Sleep Centre, Papworth Hospital, Papworth Everard, Cambridge CB3 8RE, UK
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Laitinen LA, Anttalainen U, Pietinalho A, Hämäläinen P, Koskela K. Sleep apnoea: Finnish National guidelines for prevention and treatment 2002-2012. Respir Med 2003; 97:337-65. [PMID: 12693795 DOI: 10.1053/rmed.2002.1449] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
(1) After negotiations with the Finnish Ministry of Social Affairs and Health, a national programme to promote prevention, treatment and rehabilitation of sleep apnoea for the years 2002-2012 has been prepared by the Finnish Lung Health Association on the basis of extensive collaboration. The programme needs to be revised as necessary, because of the rapid development in medical knowledge, and in appliance therapy in particular. (2) Sleep apnoea deteriorates slowly. Its typical features are snoring, interruptions of breathing during sleep and daytime tiredness. Sleep apnoea affects roughly 3% of middle-aged men and 2% of women. In Finland, there are approx. 150,000 sleep apnea patients, of which 15,000 patients have a severe disease, 50,000 patients are moderate and 85,000 have a mild form of the disease. Children are also affected by sleep apnea. A typical sleep apnea patient is a middle-aged man or a postmenopausal woman. (3) The obstruction of upper airways is essential in the occurrence of sleep apnoea. The obstruction can be caused by structural and/or functional factors. As for structural factors, there are various methods of intervention, such as to secure children's nasal respiration, to remove redundant soft tissue, as well as to correct malocclusions. It is possible to have an effect on the functional factors by treating well diseases predisposing to sleep apnoea, by reducing smoking, the consumption of alcohol and the use of medicines impairing the central nervous system. The most important single risk factor for sleep apnoea is obesity. (4) Untreated sleep apnoea leads to an increase morbidity and mortality through heart circulatory diseases and through accidents by tiredness. Untreated or undertreated sleep apnoea deteriorates a person's quality of life and working capacity. (5) The goals of the Programme for the prevention and treatment of sleep apnoea are as follows: (1) to decrease the incidence of sleep apnoea, (2) to ensure that as many patients as possible with sleep apnoea recover, (3) to maintain capacity for work and functional capacity of patients with sleep apnoea, (4) to reduce the percentage of patients with severe sleep apnoea, (5) to decrease the number of sleep apnoea patients requiring hospitalisation and (6) to improve cost effectiveness of prevention and treatment of sleep apnoea. (6) The following means are suggested for achieving the goals: (1) to promote prevention of obesity, weight loss and weight control; (2) to promote securing of nasal respiration in child patients and removal of obstructing redundant soft tissues; (3) to promote the correction of children's malocclusions, (4) to enhance knowledge about risk factors and treatment of sleep apnoea in key groups, (5) to promote early diagnosis and active treatment, (6) to commence rehabilitation early and individually as a part of treatment and (7) to encourage scientific research. (7) On the national level, the occurrence of sleep apnoea can be prevented, for example, by encouraging weight control. The programme gives examples of such measures and appeals to various authorities and voluntary organisations to reinforce their collaboration. Preventive measures should be individualised, and based on due consideration. (8) The efficacy of diagnosing sleep apnoea should be increased. Attention should be paid to the symptoms of risk group patients at different units of the primary and occupational health care. Even mild forms of the disease should be treated appropriately. Diagnosis and treatment of the disease involve cooperation between the primary and specialised health-care sectors. Methods of treatment are (1) treatment of obesity, (2) positional therapy, (3) reduction of the use of medicines impairing the central nervous system, (4) reduction of smoking and the consumption of alcohol, (5) devices affecting the position of the tongue and lower jaw, (6) treatment with Continuous Positive Airway Pressure (CPAP-treatment), (7) surgical methods of treatment and (8) rehabilitation. (9) The hierarchy of referrals in the prevention and treatment of sleep apnoea should be revised to accord a greater role to the primary health-care sector. Good exchanges of information and cooperation between the primary health care and specialised medical-care sectors should be developed. Hospitals districts in cooperation with provincial governments and municipalities should ensure that different levels of the health-care system are capable of fulfilling the tasks assigned to them appropriately. (10) Rehabilitation of sleep apnoea should be goal-orientated and cover all forms of rehabilitation: medical, occupational and social. Rehabilitation should prevent the effects caused by the disease. Thus, it is possible to support self-care, increase the patient's resources and improve quality of life. (11) Information and training should be directed primarily towards health-care personnel, patients and their families. Organisations should produce materials for health and patient education as well as organising training events. To support the activities. financing will be needed from organisations such as Finland's Slot Machine Association. The Social Insurance Institution should disseminate information about questions of social security. Regional direction and training will mainly be the responsibilities of hospital districts, provincial governments and local health centres. The media will play an important role in the dissemination in-depth information about prevention and treatment of sleep apnoea.
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Affiliation(s)
- L A Laitinen
- Hospital District of Helsinki and Uusimaa, Finland
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Affiliation(s)
- W Ward Flemons
- University of Calgary and Foothills Medical Centre, Calgary, Alberta, Canada.
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Sasse SA, Mahutte CK, Dickel M, Berry RB. The characteristics of five patients with obstructive sleep apnea whose apnea-hypopnea index deteriorated after uvulopalatopharyngoplasty. Sleep Breath 2002; 6:77-83. [PMID: 12075482 DOI: 10.1007/s11325-002-0077-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The objective of this retrospective, consecutive, case series design study was to determine the number of unselected patients with obstructive sleep apnea (OSA) who deteriorated after uvulopalatopharyngoplasty (UPPP). Sixteen of 27 patients at the Sleep Clinic at Veterans Affairs Medical Center who underwent UPPP for OSA and who completed both a pre- and postpolysomnogram were studied. After comparing the apnea-hypopnea index (AHI) before and after UPPP, three groups of patients were identified: deteriorators, unchanged, and improvers. In five patients (31%), the AHI increased by more than 10% after UPPP (deteriorators); in four (25%), the AHI showed a change in either direction of less than 10% (unchanged); and in the remaining seven (44%), the AHI decreased by more than 10% after UPPP (improvers). The AHI deteriorated in five of 16 (31%) unselected patients with OSA in our clinic population who underwent UPPP. The mean pre-UPPP AHI was lower in the patients who deteriorated relative to all other patients (P = 0.02). We suggest that patients who undergo UPPP should have a post-UPPP polysomnogram to determine whether they have improved or deteriorated after the procedure and that alternative forms of treatment may be needed in some patients.
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Affiliation(s)
- Scott A Sasse
- Department of Medicine, Section of Pulmonary and Critical Care, Long Beach Veterans Affairs Medical Center, California 90822, USA.
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