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Nomura T, Horikoshi T, Kitano Y, Yamada M, Kondo K, Kikuchi S. The morphometrical evaluation after uvulopalatopharyngoplasty. Sleep Breath 2024; 28:869-875. [PMID: 37792164 DOI: 10.1007/s11325-023-02926-w] [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: 03/22/2023] [Revised: 09/09/2023] [Accepted: 09/15/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the efficacy of uvulopalatopharyngoplasty (UPPP) and the corresponding postoperative morphometrical changes. METHODS Patients diagnosed with obstructive sleep apnea syndrome who complained of snoring and apnea were enrolled in this study. Pre- and postoperative tests, including CTs, pharyngeal volume (PV), cross-sectional area (CSA), and six-category morphometrical studies, were performed. RESULTS Of 11 patients included, 10 showed improvement of symptoms. BMI correlated with the respiratory event index (REI). In terms of PV, there was a significantly wider postoperative area. The rate of change between preoperative REI and postoperative REI (ΔREI) correlated with the amount of change of PV between preoperative PV and postoperative PV (ΔPV). CSA increased postoperatively and correlated with REI. Uvula space (UV) and distance between the hyoid bone and the base of the tongue (HB) increased postoperatively, and posterior airway space (PAS) and epiglottic space (Epi) decreased postoperatively. UV and PAS were significant (p = 0.046, 0.014). UV was related to REI. CONCLUSION Widening the PV, increasing CSA, and the posterior movement of the tongue base after UPPP surgery were found. The improvement of REI did not depend only on volume. These results suggest that it was important not only to widen the PV but also to improve the shape of the pharynx.
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Affiliation(s)
- Tsutomu Nomura
- Division of Head & Neck Surgery/Otolaryngology, Department of Comprehensive Medical Sciences, Meikai University School of Dentistry, 1-1 Keyakidai, Sakado, Saitama, 350-0283, Japan.
| | - Tomomi Horikoshi
- Department of Otolaryngology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Yuka Kitano
- Department of Otolaryngology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Masato Yamada
- Department of Otolaryngology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Kenji Kondo
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Shigeru Kikuchi
- Department of Otolaryngology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
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Zhao B, Cao Z, Xie Y, Shi Y, Zhang Y, Liu S, Chen X, Ma L, Niu X, Su Y, Feng Y, Lian C, Ren X, Liu H. The relationship of tongue fat content and efficacy of uvulopalatopharyngoplasty in Chinese patients with obstructive sleep apnea. BMC Surg 2023; 23:254. [PMID: 37635206 PMCID: PMC10463434 DOI: 10.1186/s12893-023-02144-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/08/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND To investigate the relationship between tongue fat content and severity of obstructive sleep apnea (OSA) and its effects on the efficacy of uvulopalatopharyngoplasty (UPPP) in the Chinese group. METHOD Fifty-two participants concluded to this study were diagnosed as OSA by performing polysomnography (PSG) then they were divided into moderate group and severe group according to apnea hypopnea index (AHI). All of them were also collected a series of data including age, BMI, height, weight, neck circumference, abdominal circumference, magnetic resonance imaging (MRI) of upper airway and the score of Epworth Sleepiness Scale (ESS) on the morning after they completed PSG. The relationship between tongue fat content and severity of OSA as well as the association between tongue fat content in pre-operation and surgical efficacy were analyzed.Participants underwent UPPP and followed up at 3rd month after surgery, and they were divided into two groups according to the surgical efficacy. RESULTS There were 7 patients in the moderate OSA group and 45 patients in the severe OSA group. The tongue volume was significantly larger in the severe OSA group than that in the moderate OSA group. There was no difference in tongue fat volume and tongue fat rate between the two groups. There was no association among tongue fat content, AHI, obstructive apnea hypopnea index, obstructive apnea index and Epworth sleepiness scale (all P > 0.05), but tongue fat content was related to the lowest oxygen saturation (r=-0.335, P < 0.05). There was no significantly difference in pre-operative tongue fat content in two different surgical efficacy groups. CONCLUSIONS This study didn't show an association between tongue fat content and the severity of OSA in the Chinese group, but it suggested a negative correlation between tongue fat content and the lowest oxygen saturation (LSaO2). Tongue fat content didn't influence surgical efficacy of UPPP in Chinese OSA patients. TRIAL REGISTRATION This study didn't report on a clinical trial, it was retrospectively registered.
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Affiliation(s)
- Bingjie Zhao
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157, Xiwu Road, Xi'an, Shaanxi, 710004, China
| | - Zine Cao
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157, Xiwu Road, Xi'an, Shaanxi, 710004, China
| | - Yushan Xie
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157, Xiwu Road, Xi'an, Shaanxi, 710004, China
| | - Yewen Shi
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157, Xiwu Road, Xi'an, Shaanxi, 710004, China
| | - Yitong Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157, Xiwu Road, Xi'an, Shaanxi, 710004, China
| | - Shiyu Liu
- School of Mathematics and Statistics, Xi'an Jiaotong University, No.28, Xianningxi Road, Xi'an, Shaanxi, 710049, China
| | - Xi Chen
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157, Xiwu Road, Xi'an, Shaanxi, 710004, China
| | - Lina Ma
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157, Xiwu Road, Xi'an, Shaanxi, 710004, China
| | - Xiaoxin Niu
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157, Xiwu Road, Xi'an, Shaanxi, 710004, China
| | - Yonglong Su
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157, Xiwu Road, Xi'an, Shaanxi, 710004, China
| | - Yani Feng
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157, Xiwu Road, Xi'an, Shaanxi, 710004, China
| | - Chunfeng Lian
- School of Mathematics and Statistics, Xi'an Jiaotong University, No.28, Xianningxi Road, Xi'an, Shaanxi, 710049, China.
| | - Xiaoyong Ren
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157, Xiwu Road, Xi'an, Shaanxi, 710004, China.
| | - Haiqin Liu
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157, Xiwu Road, Xi'an, Shaanxi, 710004, China.
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李 彦, 费 南, 曹 莉, 施 云, 鲜 军. [Effect of mouth breathing on upper airway structure in patients with obstructive sleep apnea]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2023; 37:529-534. [PMID: 37549944 PMCID: PMC10570098 DOI: 10.13201/j.issn.2096-7993.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Indexed: 08/09/2023]
Abstract
Objective:To compare the changes of morphology of pharynx in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and healthy individuals during oral or nasal breathing, and explore the relevant influencing factors. Methods:Twenty-nine adult patients with OSAHS and 20 non-snoring controls underwent MRI to obtain upper airway structural measurements while the subjects were awake and during mouth breathing with a nasal clip.The following were analyzed. ①The changes of upper airway structure of oral and nasal respiration in non-snoring control/OSAHS patients were observed; ②The differences and influencing factors of upper airway structure changes between OSAHS patients and controls were compared during breathing. Results:The control group consisted of 15 males and 5 females, with an apnea-hypopnea index (AHI)<5 events/h, while the OSAHS group comprised 26 males and 3 females with an AHI of 40.4±23.1 events/h and the mean lowest arterial oxygen saturation (LSaO2) was 79.5% ±10.0%. In the both groups, the vertical distance between the mandible and the posterior pharyngeal wall decreased (P<0.05); The long axis of tongue body decreased (P<0.05), and the contact area between tongue and palate decreased. There was no significant change in the total volume of the retropalatine(RP) and retroglossal(RG) airway in the control group (P>0.05). However, the minimum cross-sectional area and volume of the RP airway in OSAHS decreased (P<0.001). The lateral diameters of uvula plane in OSAHS decreased during mouth breathing, which was contrary to the trend in the control group (P=0.017). The AHI of patients was positively correlated with the reduction of the volume of the RP airway during oral breathing (P=0.001); The reduction of the distance between the mandible and the posterior pharyngeal wall was positively correlated with the length of the airway (P<0.001). Conclusion:Mouth breathing leads to the shortening of the long axis of the tongue, the reduction of the contact area between the soft palate and the tongue, vertical distance between the mandible and the posterior pharyngeal wall, and the cross-sectional area of the epiglottis plane. These changes vary between OSAHS patients and controls. During mouth breathing, the diameters, areas and volumes of the RP area decreased, and were more significant in severe cases.
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Affiliation(s)
- 彦如 李
- 首都医科大学附属北京同仁医院耳鼻咽喉头颈外科 耳鼻咽喉头颈科学教育部重点实验室(首都医科大学)(北京,100730)Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery[Capital Medical University], Ministry of Education, Beijing, 100730, China
| | - 南希 费
- 首都医科大学附属北京同仁医院放射科Department of Radiology, Beijing Tongren Hospital, Capital Medical University
| | - 莉莉 曹
- 首都医科大学附属北京同仁医院耳鼻咽喉头颈外科 耳鼻咽喉头颈科学教育部重点实验室(首都医科大学)(北京,100730)Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery[Capital Medical University], Ministry of Education, Beijing, 100730, China
| | - 云瀚 施
- 首都医科大学附属北京同仁医院耳鼻咽喉头颈外科 耳鼻咽喉头颈科学教育部重点实验室(首都医科大学)(北京,100730)Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery[Capital Medical University], Ministry of Education, Beijing, 100730, China
| | - 军舫 鲜
- 首都医科大学附属北京同仁医院放射科Department of Radiology, Beijing Tongren Hospital, Capital Medical University
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