A preoperative sleep study with nasal airway occlusion in pharyngeal flap surgery

Abstract

Purpose Obstructive sleep apnea is a major complication of pharyngeal flap surgery. The purpose of the present study is to predict preoperatively the risk of upper airway obstruction after surgery. Material and methods We performed an overnight sleep study preoperatively and postoperatively in 16 pediatric patients considered for pharyngeal flap surgery. Preoperative sleep study was done for two nights, once in normal breathing condition and once with complete nasal occlusion by packing of nostril with tampon gauze. Results In preoperative sleep recordings in normal breathing condition, all subjects had a normal apnea hypopnea index (AHI) less than 5/h. In preoperative recording with complete nasal occlusion, five patients exceeded 5/h in AHI. In particular, for two patients who had AHI higher than 15/h, we gave up a surgery in one case and performed pharyngeal flap operation for the other following a tracheotomy for severe disturbance of oral breathing. The remaining 14 subjects underwent surgery without airway obstructive complications. There was strong correlation between preoperative AHI with nasal tampon gauze and AHI at two weeks postoperatively (r = 0.88 P < .0001). There was no significant correlation between preoperative AHI in normal breathing condition and postoperative AHI (P > .05). Conclusions These results exhibit preoperative sleep study with complete nasal airway occlusion represent postoperative breathing condition well during early postoperative period. Preoperative sleep study with complete nasal airway occlusion with nasal tampons could be useful for predicting the risk of upper airway obstruction secondary to pharyngeal flap surgery.