Abstract
Background: Obstructive sleep apnea (OSA) has cardiovascular, neurological, and social complications. Surgical treatment has the potential to improve airway patency but when and which surgery should be done is a controversy. Aims and objectives: To estimate the site of obstruction in patients with OSAS and to assess the surgical results of the site (of obstruction) directed surgical treatment. Methodology: Twenty patients with OSAS were included in the study with Eight adults and Twelve children. It was a prospective study. All patients were assessed for the airway collapse and surgery was done accordingly. Repeat PSG was done after surgery for success rate after 4 months of follow up. Result: 17 patients successfully completed the follow-up. Four (50%) adults and Two (17%) children have grade I or II tonsils while Four (50%) of adults and Ten (83%) children have tonsil size grade III or IV. Seven (88%) adults and one (8%) of the children have adenoid hypertrophy up to grade II. One adult (12%) and nine children (75%) have grade III Adenoid size. Two children (17%) have Adenoid grade IV size. In Four patients retropalatal more than retroglossal collapse was found (50%). One patient (12%) had retroglossal more than retropalatal collapse other one had only retropalatal collapse, and the other one had retroglossal collapse. ESS (Epworth sleepiness scale) decreased postoperatively in both groups. There is a significant change in AHI with the median pre-op AHI being 40.19 to median post-op AHI being 11.35 with a p-value 0.017. Apnea-hypopnea index (AHI) in children pre-operatively was 12.98 (median) changed to 2.15 (median) which is statistically significant. Only one adult patient (12%) is surgically cured while in five patients (63%) surgical success achieved with a surgical success rate of 5/8 (63%). Whereas only one patient is surgically cured 1/8 (13%). Eight patients achieved surgical success with a total success rate of 8/9 (89%). While only two patients achieved surgical cure (23%) among children. Conclusion: The outcome of site-directed surgical treatment is that it is a satisfactory way of treatment of OSAS with an overall success rate of 76%.
Highlights
Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder
Treatment by CPAP is considered as gold standard it leads to the patient being dependent on the CPAP machine which is required to be worn and switched on whenever the patient sleeps
In our study we have found results (89% success rate) comparable to the published result of success rate of surgical treatment of OSAS
Summary
Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder. The OSA S (obstructive sleep apnoea syndrome) is characterized by repeated partial or complete closure of the pharynx, gasping episodes, sleep fragmentation, and day time sleepiness [4]. Clinical features of OSA are poor sleep pattern and witnessed breath-hold, excessive day time sleepiness, nocturia. Treatment by CPAP is considered as gold standard it leads to the patient being dependent on the CPAP machine which is required to be worn and switched on whenever the patient sleeps. This may be unacceptable to some patients and compliance to this treatment can be variable. Surgical treatments have been limited by the inadequacy of current evaluation techniques to accurately localize the site of dynamic obstruction, and the exact indications for the various proposed surgical procedures remain not precisely elucidated
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