Abstract
The objective was to investigate whether tongue base suspension with uvulopalatopharyngoplasty (UPPP) is beneficial on polysomnography analysis for sleep quality in patients with obstructive sleep apnea (OSA) anatomically classified as Fujita type III (small tonsils and a bulky tongue base). In the retrospective study, the charts of 36 patients with OSA that underwent tongue base suspension with UPPP from 2012 through 2015 were reviewed. The surgical outcome measured according to Sher’s classification (AHI reduction > 50% and AHI < 20 per hour as success group, otherwise as failure group). The pre- and post-operative sleep quality parameters were evaluated, and the total sleep time changes were evaluated based on electroencephalography study, slow wave sleep, sleep efficiency, rapid eye movement sleep percentile, and Epworth sleep scale scores. Respiratory, the outcomes of polysomnography analysis were then compared between the successful surgery and surgical failure groups during a 1-year follow up. Total arousals and reduced respiratory arousal indices, along with unchanged periodic leg movement and spontaneous electroencephalography arousal indices, were observed in the successful surgery group but not in the surgical failure group. There were 66% resulted in surgical success by this surgery, and 34% as in failure group according to Sher’s criteria. Patient sleep quality was further improved by reducing the respiratory arousal index and increasing the rapid eye movement sleep percentile during the 1-year follow up.
Highlights
The prevalence of obstructive sleep apnea (OSA) has increased in contemporary society, and moderate to severe OSA has been diagnosed in 49.7% men and 23.4% women[1]
The present study investigated whether tongue base suspension with UPPP can improve sleep quality in patients with OSA diagnosed as having small tonsils and a bulky tongue base
A comparison between the pre- and post-operative arousal parameters in the successful surgery and surgical failure groups revealed that two of the four arousal parameters in the respiratory arousal index decreased considerably but periodic leg movement (PLM) and spontaneous EEG arousal indices did not decrease in the successful surgery group (Tables 3 and 4)
Summary
The prevalence of obstructive sleep apnea (OSA) has increased in contemporary society, and moderate to severe OSA has been diagnosed in 49.7% men and 23.4% women[1]. Sleep surgery is considered an alternative treatment strategy for patients who cannot tolerate CPAP7, and the success rates of uvulopalatopharyngoplasty (UPPP) in moderate and severe OSA patient groups were 42.5% and 26.5%, respectively[8]. The UPPP success rate is unsatisfactory in patients with small tonsils and a bulky tongue base, and additional therapy for the tongue base is recommended, for patients with anatomical tongue-base obstruction during sleep[9]. The retropalatal and retrolingual collapse decreased and spaces increased after tongue base suspension with UPPP13 Whether this combined surgery can improve sleep arousals, sleep quality, rapid eye movement (REM) sleep percentile, and non-REM stage sleep percentile in patients with OSA has been insufficiently discussed. The present study investigated whether tongue base suspension with UPPP can improve sleep quality in patients with OSA diagnosed as having small tonsils and a bulky tongue base
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