Abstract
snoring and obstructive sleep apnea syndrome (OSAS) are a serious medical problem, as they lead to a complex of complications from various body systems, disrupt the socio-economic sphere and stigmatize patients. To date, a set of treatments has been developed, the most effective of which are conservative therapy using CPAP and surgical interventions - various modifications of uvulopalatopharyngoplasty. However, only a small number of studies have elucidated soft palate tissue pathology in patients with chronic and OSAS. But understanding the morphological changes is one of the key aspects for the development of treatment tactics. The aim of current study is to justify the choice of surgical intervention in the treatment of snoring and OSAS by description of morphological changes of the soft palate and to estimate the impact of HPV infection on the progression of soft palatine remodeling. The study included soft palatine tissue samples, which were removed during surgery for snoring and OSAS in 15 patients. Histological (H&E) and immunohistochemical techniques (Ki-67, p16, Human Papilloma Virus). All patients were divided in two groups according HPV-positivity: 5 persons in HPV-positive group and 10 persons in HPV-negative group. For indicators were estimated: number of cellular layers (CL), number of intraepithelial lymphocytes (per 100 epitheliocytes) (IEL), number of vessels per x100 field (NV), Ki-67 proliferation index (PI). Results shows in HPV+ group: CL - 24,2 (±2,17); IEL - 37,8 (±20,97), NV - 21 (±8,46); PI - 17,6 (±2,51). In HPV- group: CL - 6 (±4,78); IEL - 3,3 (±1,77); NV - 10,7 (±2,67); PI - 7,3 (±2,71). Mann-Whitney criterion shows statistical significant difference between groups for all mentioned indicators. In conclusion: patients with snoring and obstructive sleep apnea syndrome had hypertrophy of the soft palate structures caused by changes in epithelial and connective tissue components. Subepithelial structures underdo the disorganization of connective tissue components with a violation of the histoarchitectonics of collagen fibers, edema and angiomatosis. Thus, the study revealed a number of irreversible pathological processes of soft palate tissues, which is the basis for the choice of surgical treatment tactics including the resection of excess tissue. At the same time HPV-infection leads to more pronounced changes in the epithelial layer and subepithelial tissue with concomitant inflammation that likely to create a negative background for further treatment of OSA syndrome.
Highlights
Obstructive sleep apnea (OSA) is referring to one of the most prevalent sleep disorders worldwide and is caused by repetitive episodes of nocturnal breathing cessation due to upper airway collapse (Spicuzza, Caruso, & Di Maria, 2015)
Frequent and prolonged episodes of OSA leads to the development of obstructive sleep apnea syndrome (OSAS) which includes nocturnal sleep disruptions, decrease in general quality of sleep and consequent excessive daytime sleepiness (Mannarino, Di Filippo, & Pirro, 2012)
Previous studies have shown that patients with untreated severe OSA have a significantly higher risk of fatal (OR) - 2.87) and non-fatal (OR - 3.17) episodes of cardiovascular disease compared with group of healthy people (Lévy et al, 2015)
Summary
Obstructive sleep apnea (OSA) is referring to one of the most prevalent sleep disorders worldwide and is caused by repetitive episodes of nocturnal breathing cessation due to upper airway collapse (Spicuzza, Caruso, & Di Maria, 2015). Frequent and prolonged episodes of OSA leads to the development of obstructive sleep apnea syndrome (OSAS) which includes nocturnal sleep disruptions, decrease in general quality of sleep and consequent excessive daytime sleepiness (Mannarino, Di Filippo, & Pirro, 2012). Numerous of studies have shown strong correlation between OSAS and different cardiovascular diseases. These include congestive heart failure, arterial hypertension and cerebrovascular disorders (Lévy et al, 2015). Previous studies have shown that patients with untreated severe OSA have a significantly higher risk of fatal (OR) - 2.87) and non-fatal (OR - 3.17) episodes of cardiovascular disease compared with group of healthy people (Lévy et al, 2015)
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