Postoperative Sleep Studies Research Articles

Transpalatal Advancement Pharyngoplasty for Obstructive Sleep Apnea Syndrome: Results and Analysis of Failures

To assess the polysomnographic outcomes of patients with obstructive sleep apnea undergoing transpalatal advancement pharyngoplasty for retropalatal collapse and to compare responders with nonresponders to surgery. Retrospective medical record review. Tertiary referral teaching hospital and private practice. Sixty patients undergoing transpalatal advancement pharyngoplasty alone at a single sitting with preoperative and postoperative sleep studies were reviewed. Transpalatal advancement pharyngoplasty. Preoperative and postoperative polysomnographic data were analyzed and comparisons were assessed between responders and nonresponders. Following surgery, the mean (SD) respiratory disturbance index (RDI) decreased from 37.2 (20.4) to 15.4 (12.3), with an overall change of 21.8 (21.8) (95% confidence interval [CI], 16.2-27.4). Similarly, the mean (SD) arterial oxygen saturation nadir after transpalatal advancement pharyngoplasty surgery improved from 83.9% (5.4%) to 87.4% (4.3%), with an overall change of 3.5% (5.9%) (95% CI, 2.0%-5.0%). Between the traditional Gothic arch incision (n = 31) and the propeller incision (n = 29) an observed 31% (95% CI, 7%-51%) difference in success rate in favor of the latter was noted. Transpalatal advancement pharyngoplasty appears to be an effective and safe treatment option in selected patients. No preoperative variable was associated with surgical success in this study. The association of the propeller incision and surgical success requires further analysis.

Tolerance of Positive Airway Pressure following Site-Specific Surgery of Upper Airway

A significant proportion of patients may require the continued use of positive airway pressure (PAP) following upper airway surgery. The objective of this study is to determine whether site-specific surgical modification of upper air- way improved tolerance to PAP treatment in those patients who continued to use PAP following surgery. Medical records of patients who underwent site-specific surgical modification of upper airway were identified on retrospective chart re- view. Of the 45 patients who had both preoperative and postoperative sleep studies and were successfully contacted, only 16 patients used PAP prior to the surgery and continued to use it following the surgery. Preoperative and postoperative AHI, lowest oxygen saturation, ESS, PAP pressure, PAP tolerability, number of hours per night of PAP use, and BMI were retrieved from medical records as well as phone interviews. Statistical analysis was performed using paired-samples t-tests in these 16 patients. Most of the 16 patients who continued to use PAP following the surgery did not respond to surgical treatment even though there was a statistically significant drop in AHI (p=0.027). Only 3 patients in this group were considered responders but they chose to continue the use of PAP because they continue to derive benefit from its use. Majority of these patients underwent UPPP in conjunction with some types of base of tongue procedure(s). Following surgery, statistically significant improvement in PAP tolerance (p=0.003), increased PAP use (p=0.015) and decrease in ti- trated PAP pressure (p=0.013) were noted. We found in this study that tolerance and compliance of PAP improved fol- lowing site-specific upper airway surgery.

Obstructive Sleep Apnea in an Infant With Prominent Glossopharyngeal Muscles: Therapy and Outcome

We present a case of prominent glossopharyngeal muscles causing severe obstructive symptoms in a 3-month-old child. Preoperative sleep studies and dynamic microdirect laryngoscopy were used in evaluation of the patient. Postoperative sleep studies confirmed a substantial reduction in apneic events after release of the muscle folds. The literature addresses the variant anatomy, and treatment options are discussed. To our knowledge, this is the first case report of prominent glossopharyngeal muscles leading to apneic events. We propose that in patients with prominent glossopharyngeal folds, surgical release may significantly improve symptoms of sleep apnea and in severe cases prevent tracheostomy.

Infant Mandibular Distraction With an Internal Curvilinear Device

Mandibular distraction has proven to be a valuable tool for lengthening the hypoplastic mandible and relieving airway obstruction in infants. Numerous devices have been developed to achieve the desired mandibular lengthening. Complications including poor vector control, need to mold regenerate, facial scarring, external pin loosening, and bulky hardware have been associated with previous devices. In an attempt to circumvent some of these problems, the senior author developed an internal curvilinear device (Osteomed Corporation, Dallas, TX), which is applicable to the infant mandible. The aim of this paper is to describe the use of this distractor as well as its indications and outcomes.Twelve micrognathic infants (ages range from 9 days to 8 months) who underwent mandibular distraction between March 2005-May 2006 at Lucile Packard Children's Hospital were included in the study. Preoperative workup included an evaluation by a multidisciplinary team including a pediatric otolaryngologist, neonatal intensivist, pediatric pulmonologist, occupational therapist, and craniofacial surgeon. Pre and postoperative maxillomandibular discrepancy, sleep study, feeding evaluation, and three-dimensional computerized tomography scans were compared. All patients tolerated the distraction process well to completion without postoperative complication, except for one patient who had temporary facial nerve weakness, which resolved in 2 months. All patients with obstructive apnea had the obstructive component improved. The last six patients had pre and postoperative polysomnograms to document the improvement. Two patients with neurologic impairment had persistent central apnea. One nonsyndromic patient with inability to feed and feeding-related airway obstruction was taking complete oral feeds 2 weeks after distraction.Mandibular distraction with an internal curvilinear device is effective at relieving airway obstruction in micrognathic infants, while avoiding some previously reported complications.

OSAS in Down syndrome: T&A versus T&A plus lateral pharyngoplasty

Obstructive Sleep Apnea Syndrome (OSAS) is common in children with Down syndrome (DS). Adenotonsillectomy (T&A) has traditionally been the initial surgical treatment. More aggressive surgery has also been recommended. Previous studies have used parental reporting and not objective data to assess treatment outcomes. Polysomnography (PSG) is used to objectively evaluate the results of T&A versus T&A plus lateral pharyngoplasty in the initial treatment of OSAS in children with DS. This is a retrospective study of children with OSAS and DS. Group 1 consisted of 21 children with DS who underwent T&A. Group 2 consisted of 16 children of similar age who had T&A plus lateral pharyngoplasty as initial surgical treatment. Post-operative PSG's were available for all patients. Apnea/hypopnea index (AHI), presence of hypoxemia and hypercarbia, and arousal index were measured and compared. In group 1, after T&A, 48% continued to have an elevated AHI. If hypercarbia and hypoxemia are included in the result analysis, 67% continued to have abnormal PSG's after their surgery. In group 2, 63% had an elevated AHI post-operatively. When hypercarbia and hypoxemia are included in the analysis, 75% continued to have abnormal PSG's after surgery. There was no statistically significant difference in the outcome of the two groups. Pediatric patients with OSAS and DS may show improvement after T&A, however only about one third will have a normal post-operative sleep study. Adding a lateral pharyngoplasty does not improve these results. Further study with objective outcome data is needed to determine a better first line surgical treatment for these patients.

Quality of Life 17 to 20 Years After Uvulopalatopharyngoplasty

To study the long-term quality of life outcomes of a group of unselected patients for the long-term effects of uvulopalatopharyngoplasty (UPPP). Retrospective chart review and telephone survey. Forty-nine patients who underwent UPPP between July 1980 and July 1983 and who had their medical records were reviewed and were asked to grade on a visual analogue scale (VAS) the clinical benefits and complications of UPPP after the surgery. Forty-three (87.8%) males and six (12.2%) female patients were studied. Improvement in snoring, excessive daytime somnolence, and nocturnal arousals were seen after UPPP with decreased effectiveness after time. The most common complication of UPPP was velopharyngeal insufficiency (VPI) (28.5%); however, dry throat and swallowing difficulty tended to be more severe in those patients who had them. No correlation between the snoring and VPI VAS grades was observed. Forty-three patients had a preoperative sleep study and 22 patients a postoperative sleep study. There was lack of correlation between the significant subjective clinical improvement and their postoperative polysomnography. When undertaking UPPP, both subjective and objective benefits should be weighed against the risk of long-term ill effects. Patients should also be warned that the long-term side effects such as VPI, dry throat, and abnormal swallowing sensation might be more common than previously expected.

Outcomes of Hyoid Suspension for the Treatment of Obstructive Sleep Apnea

To examine the efficacy of hyoid myotomy and suspension as a treatment of hypopharyngeal obstruction in obstructive sleep apnea. Prospective, observational study. Academic medical center. Twenty-nine consecutive male patients with suspected hypopharyngeal obstruction Patients underwent hyoid suspension. Uvulopalatopharyngoplasty with or without tonsillectomy was performed at the same time for those patients who had not undergone this procedure previously. Patients underwent clinical examination and sleep study prior to surgery and approximately 1 year postoperatively. Primary outcome was a successful surgical result, defined as apnea-hypopnea index lower than 20, 50% or greater decline in apnea-hypopnea index, and no oxygen desaturations below 85% on the postoperative sleep study. Secondary outcomes included daytime sleepiness as determined by the Epworth Sleepiness Scale and the severity of snoring. Postoperative complications were also recorded. Only 5 (17%) of 29 patients achieved a successful outcome. The respiratory disturbance index did not change significantly for the group as a whole, although the lowest oxygen saturation did show some improvement. Hyoid suspension does not provide results equivalent to those reported for genioglossus advancement or multisession tongue radiofrequency. Hyoid suspension alone is not an efficacious treatment for hypopharyngeal airway obstruction in most patients with obstructive sleep apnea.

Effects of adenotonsillectomy on vaso-occlusive events in sickle cell disease patients

Problem: To evaluate the effect of adenotonsillectomy on sleep apnea, hypoxia, surgical complications, and vaso-occlusive events (VOC) in children with sickle cell disease (SCD). Methods: A retrospective chart review of children with SCD presenting with upper airway obstruction who underwent tonsillectomy or adenotonsillectomy between 1997 and 2003 with the outcome measures of perioperative management, postsurgical complications, surgical length of stay, preop and postop pulse oximetry, major VOC requiring hospitalization, and other hospitalizations. Results: Thirty-two patients were identified with the above criteria (2 tonsillectomy and 30 adenotonsillectomy); 28% had preoperative sleep studies and 6% had postoperative sleep studies. All patients, except 1 who refused for religious reasons, received outpatient preoperative transfusions if hematocrit was <30 (n = 26). The average length of stay for elective surgery was 1.7 days with 17.2% complications (5 desaturations on pulse oximetry, 1 acute chest syndrome, 1 vaso-occlusive pain). Sixty-nine percent were monitored for <24 hours. For 1 and 2 years before and after surgery, there was no significant difference between the number of major VOC ( P = 0.5343, P = 1) or hospitalizations ( P = 0.7176, P = 0.8487). Outpatient pulse oximetry improved after surgery (93.78% vs 95.50%); however, it did not reach statistical significance ( P = 1.061). Conclusion: Children with SCD undergoing adenotonsillectomy can be managed preoperatively with outpatient transfusions. The majority of patients can be monitored for 24 hours, similar to other high-risk populations, but should be carefully assessed for pain control or oxygen desaturation. There is no significant difference in rates of hospitalization or major VOC after tonsillectomy/adenotonsillectomy for upper airway obstruction. Outpatient pulse oximetry improved but was not statistically significant. Significance: This study suggests that adenotonsillectomy may not influence the number of hospitalizations or vaso-occlusive events of SCD patients, though a prospective study is needed to verify these data. However, if adenotonsillectomy is performed, SCD patients can be managed perioperatively similarly to any other high-risk patients. Support: None reported.

The efficacy of anatomically based multilevel surgery for obstructive sleep apnea

Objective Most reports in the literature focus on the efficacy of a single procedure for obstructive sleep apnea (OSA). We review the overall efficacy of a surgical methodology based on localizing the level of anatomic obstruction for each patient and surgical correction of the nasal, oropharyngeal, or hypopharyngeal obstruction. Study design and setting Retrospective review of cases performed by a single practitioner using a systematic approach to surgery for OSA with preoperative and postoperative sleep studies. Results Forty-two patients with a respiratory disturbance index (RDI) greater than 15 were included in the study. Surgery involved at least 2 levels of obstruction usually performed in 2 stages. All patients reported symptomatic improvement. Overall, 83.3% (35 of 42) of patients were cured according to the accepted RDI criteria of more than 50% reduction and final RDI of less than 20. All 21 patients with mild OSA (RDI, <29), 73% of patients with moderate OSA (RDI, 30 to 49), and 50% of patients with severe OSA (RDI, >50) were cured. Conclusion The use of an anatomically based methodology in approaching patients with OSA seems to offer a higher efficacy than a single procedure as reported in the literature.

The efficacy of anatomically based multilevel surgery for obstructive sleep apnea.

Most reports in the literature focus on the efficacy of a single procedure for obstructive sleep apnea (OSA). We review the overall efficacy of a surgical methodology based on localizing the level of anatomic obstruction for each patient and surgical correction of the nasal, oropharyngeal, or hypopharyngeal obstruction. Study design and setting Retrospective review of cases performed by a single practitioner using a systematic approach to surgery for OSA with preoperative and postoperative sleep studies. Forty-two patients with a respiratory disturbance index (RDI) greater than 15 were included in the study. Surgery involved at least 2 levels of obstruction usually performed in 2 stages. All patients reported symptomatic improvement. Overall, 83.3% (35 of 42) of patients were cured according to the accepted RDI criteria of more than 50% reduction and final RDI of less than 20. All 21 patients with mild OSA (RDI, <29), 73% of patients with moderate OSA (RDI, 30 to 49), and 50% of patients with severe OSA (RDI, >50) were cured. The use of an anatomically based methodology in approaching patients with OSA seems to offer a higher efficacy than a single procedure as reported in the literature.

Long-Term Results of Tracheostomy for Severe Obstructive Sleep Apnea Syndrome

Severe obstructive sleep apnea (OSAS) is most often accompanied by metabolic syndrome, obesity, diabetes and coronary disease. In its most severe form, it is a life-threatening condition, requiring active and immediate help. Nasal continuous positive airway pressure (CPAP) is the most efficient nonsurgical treatment for patients with OSAS. However, for anatomical, disease-related and subjective reasons, many patients cannot accept this treatment. A permanent tracheostomy may be one alternative in such patients who, in addition, often suffer from extreme obesity and severe heart disease. In this paper, we describe the long-term follow-up results of 7 patients suffering from OSAS and treated with permanent tracheostomy. All the patients (5 men, 2 women) were diagnosed using the static charge sensitive bed method and night-time oximetry for sleep analysis. The mean body mass index (BMI) of the patients ranged from 34 to 60 and the age from 41 to 64 years. All the patients had severe OSAS and long periods of low oxygen saturation (SaO₂) levels. Six patients had a CPAP trial before tracheostomy. Only 2 patients tolerated the trial but, despite the continuous use of CPAP, they were nonresponders. Permanent tracheostomy was done according to normal routine in each patient. After primary healing of 2 days, they used silver cannulae, which also allowed them to speak. The patients were evaluated every year after the tracheostomy. After some practical difficulties including proper maintenance of the cannula, all the patients quickly learned the correct management. In postoperative sleep studies, nadir SaO₂ levels had improved significantly, obstructive apneas had disappeared and the subjective quality of life had improved. No marked changes in BMI were found.

Long-term follow-up of obstructive sleep apnea syndrome following surgery in children and adults.

Obstructive sleep apnea syndrome (OSAS) is characterized by recurrent apneas during sleep, resulting in repetitive hypoxemia. The present study retrospectively analyzed subjective and objective assessments of the patients with OSAS in a relatively long-term follow-up. From February 1986 to August 1996, 53 patients received surgical treatment for OSAS and snoring. Thirty-seven (27 males and 10 females) out of 53 patients completed the questionnaire and postoperative sleep study was obtained in 6 patients. In 20 children (<15 years), snoring, sleep apnea, and daytime sleepiness completely disappeared in 12, 19, and 16, and improved in 8, 1, and 4, respectively. These findings confirm that tonsillectomy and/or adenoidectomy in children may be the first selection for treatment. In 17 adults, snoring, sleep apnea, and daytime sleepiness completely disappeared in 2, 5, and 8, improved in 11, 8, and 7, and was unchanged in 4, 4, and 1, respectively. The apnea index in adults was significantly decreased in both early and late postoperative periods. These results suggest that surgery is a satisfactory alternative for adult patients if performed accurate preoperative diagnosis of the localization of the airway collapse and careful long-term follow-up.

Pre-and post-operative respiratory assessment of acromegalics with sleep apnea--bedside oximetric study for transsphenoidal approach.

Although routine mechanical nasal packing after transsphenoidal surgery (TS) is thought to increase respiratory disorders during sleep, there has been little in the literature about the pre- and post-operative airway assessment of acromegalics with sleep apnea (SA). We describe 4 acromegalic patients with SA, who underwent transsphenoidal surgery. METHODS AND CASES: The patients were all men, aged from 47 to 59 years. The pre- and post-operative sleep study consisted with a computer calculated oximetry parameter of oxygen desaturation index (ODI), which was defined as the number/hour of oxygen desaturation episodes exceeding 4% from the base line (normal range < 15). The postoperative (postop.) sleep study was carried out from the 1st postop. day to the 8th day, for 1 to 8 days, varying for each patient. Only the worst postop. result is shown. Patient 1 had 2 operations, 2 years apart. ODI was 39.6 before the 1st operation and 45.9 postop.. In the second operation ODI was 21.8 preoperatively (preop.) and 57.9 postop.. Preop. and postop. ODI was 18.1 and 22.2 in patient 2, 21.6 and 22.5 in patient 3 and 45.5 and 18.9 in patient 4, respectively. ODI of patient 4 was 39.6, 3 weeks later. Our data showed that the postop. oxymetric study commonly showed worse results in acromegalics with nasal packing. The better result of patient 4 was probably due to a postop. sleepless state. REM sleep usually increases in the first several postop. days, when cardiopulmonary complications are more likely to occur. Since acromegalics with severe SA and postop. nasal packing may more readily suffer from cardiopulmonary complications, postoperative meticulous respiratory monitoring and care should be mandatory.

Early polysomnographic findings and long-term subjective results in sleep apnea patients treated with laser-assisted uvulopalatoplasty.

To examine the long-term results of laser-assisted uvulopalatoplasty (LAUP) for the treatment of patients with obstructive sleep apnea syndrome (OSAS). One hundred eighty-two OSAS patients treated with LAUP were followed for an average of 4 years. Of these patients, 131 have completed treatment. Complete polysomnographic data are available on 48 patients. Five patients were eliminated owing to nasal surgery performed during the period between the preoperative and postoperative sleep studies, thus 43 patients were included who had only LAUP treatment. Another three patients were eliminated because their postoperative polysomnograms were performed less than 6 weeks after the last procedure. Complete long-term subjective data are available on 31 patients. Between July 1993 and July 1998, 1038 patients were evaluated for LAUP treatment for snoring and OSAS. Of the 1038 patients, 409 were treated with LAUP and the remaining 629 were treated with other surgical procedures, devices, or behavior modification. The 40 patients who underwent only LAUP treatment for OSAS and have complete polysomnographic data are the focus of this study. The significant objective polysomnographic findings include a decrease in the respiratory disturbance index (RDI) from 25.0 +/- 2.8 to 15.3 +/- 2.9 (P = < .0001), and a decrease in the apnea index (AI) from 14.6 +/- 2.6 to 9.0 +/- 2.4 (P = .00248). In addition, the percentage of time spent in rapid eye movement (REM) sleep significantly increased after LAUP, from 13.3% +/- 1.0 to 17.6% +/- 1.4 (P = .0149). The long-term subjective results indicate that the presenting complaints were improved after LAUP in 74.9% +/- 4.1 with a mean follow-up of 4.04 years +/- 72 days (median, 4.63 y). LAUP remains a safe and effective treatment for carefully selected patients suffering from OSAS. Five years after LAUP was introduced in the United States, objective polysomnographic data demonstrate reduction in the RDI and increased time spent in REM sleep after treatment. In addition, the long-term subjective results show that the presenting symptoms were no longer present in 75% of patients treated with LAUP.

Infants undergoing pyloromyotomy are not at risk for postoperative apnea. Staff of Sutter Community Hospitals Sleep Disorders Center.

Thirty term infants undergoing general anesthesia and pyloromyotomy had pre- and postoperative sleep studies to determine whether these infants were at risk for postoperative apnea. Sleep studies showed an improved respiratory disturbance index (RDI) after surgery. Postoperatively, apnea indices were lower and lowest oxygen saturation values were increased compared to the infants' preoperative status. We conclude that pyloromyotomy does not elicit postoperative apnea in term infants.

Short-term objective and long-term subjective results of laser-assisted uvulopalatoplasty for obstructive sleep apnea.

To determine the short-term and long-term effects of laser-assisted uvulopalatoplasty (LAUP) on symptoms and polysomnographic measures in patients with obstructive sleep apnea syndrome (OSAS). Prospective assessment of outcomes after LAUP in patients with OSAS. Fifty-nine patients with OSAS underwent LAUP, and 36 completed postoperative sleep studies. Questionnaires ranking snoring and apneic symptoms were completed by the patient and bed partner before LAUP, 6 to 12 weeks after LAUP, and in the long term (> 2 years). The apnea index decreased from 14.4 to 5.8 (P = .0012), respiratory disturbance index (RDI) decreased from 28.1 to 7.9 (P = .0046), and the mean lowest oxyhemoglobin saturation increased from 80.6% to 84.0% (P = .055). The RDI was reduced to 10 or less in 44.4% of patients. Subjective questionnaires showed statistically significant improvements in snoring, morning fatigue, morning headaches, daytime somnolence, and daytime psychometric measures. The symptomatic improvement persisted in the long term. LAUP is an effective method for the management of OSAS. We have demonstrated short-term improvement in polysomnographic measures and short-term and long-term improvement in subjective measures.

Sleep-Disordered Breathing in Acromegalics. Relation of Hormonal Levels and Quantitative Sleep Study by Means of Bedside Oximeter.

Sleep-disordered breathing (SDB) is common in patients with growth hormone (GH) secreting pituitary adenomas. Since long-term untreated SDB aggravates systemic conditions (hypertension and arrhythmia etc.), the therapeutic outcome of SDB is important in reducing morbidity and mortality rates. But the results of a quantitative analysis of the lowered GH and IGF-1 levels in SDB in a relatively large number of patients are not detailed. Ten consecutive acromegalic patients were studied with a bedside oximeter. Preoperatively they were divided into two groups based on the presence (SDB group = 6 patients) or absence (non-SDB group = 4 patients) of clinical symptoms of SDB such as habitual snoring, excessive daytime somnolence and nocturnal apneic episodes. The serum IGF-1 averaged 931.7 ng/ml in SDB group and 898.3 ng/ml in non-SDB group. The oxygen desaturation index (ODI) (the number of oxygen desaturations exceeding 4% from the base line) was 29.1+/-15.4 in the SDB group and 2.5+/-1.8 in the non-SDB group (P=0.01). Other oximeter parameters such as the percent of the time spent at O2 saturation < 90% and the mean and the lowest O2 saturations closely correlated with the degree of the clinical symptoms. A postoperative sleep study was conducted in 5 patients in the preoperative SDB group, 4 months or more after the surgery. The serum GH and IGF-1 levels normalized in 3 patients but remained slightly high in 2. ODI became 9.1+/-5.6, which was significantly lower than the preoperative value (P=0.026). One patient had a complete clinical resolution. The other 4 obtained slight to moderate improvement clinically and oximetrically despite normalized or decreased hormonal levels. This study clarified that the response of SDB to lowering of the GH level varies from one patient to another and persisting SDB despite the normalization of the hormonal levels suggests the involvement of other factors in the production of SDB.

Polysomnography after adenotonsillectomy in mild pediatric obstructive sleep apnea

a) To determine the need for intensive monitoring on the first operative night of surgery in children undergoing adenotonsillectomy for mild obstructive sleep apnea; b) to examine the effect of narcotics on postoperative obstructive sleep apnea. Randomized, prospective study. University hospital. Children, ranging in age between 1 and 18 yrs, presented to the Pediatric Otolaryngology Clinic for adenotonsillectomy for mild obstructive sleep apnea defined as from one to 15 obstructive apnea events per hour on preoperative polysomnogram. Patients were assigned to receive either a narcotic- or a halothane-based anesthetic for adenotonsillectomy. A postoperative polysomnogram was performed in the pediatric intensive care unit on the first operative night. Eighteen patients were recruited, 15 of whom met inclusion criteria: nine patients received a halothane-based anesthetic and six patients received a fentanyl-based anesthetic. When the data were analyzed by pooling both groups, the differences between pre- and postoperative sleep studies demonstrated a reduction in the number of obstructive events and less severe oxygen desaturations on the operative night. Total sleep time between the two sleep studies decreased from 371 +/- 13 to 304 +/- 14 mins. The number of obstructive apnea events/hr decreased as well. The lowest oxygen saturation measured during rapid eye movement sleep was 78 +/- 5% preoperatively and 92 +/- 1% postoperatively. Our data suggest that children without underlying medical conditions, neuromotor diseases, or carniofacial abnormalities, 1 to 18 yrs of age, who suffer from mild obstructive sleep apnea, have improvements documented by polysomnography on the night of surgery following adenotonsillectomy and do not necessarily need to be monitored intensively. These findings were not significantly affected by the choice of intraoperative anesthetic.

Laser‐Assisted Uvulopalatoplasty for Obstructive Sleep Apnea

Laser-assisted uvulopalatoplasty (LAUP) can reduce snoring by sequentially removing excessive vibratory tissue of the velopharynx. The procedure can be performed under local anesthesia in an office setting. Since the appearance of the soft palate is similar after both LAUP and uvulopalatopharyngoplasty, LAUP may also be efficacious in the management of obstructive sleep apnea syndrome (OSAS). LAUP was performed in 34 consecutive prospectively evaluated patients with OSAS. Of the 34 patients, 28 (82%) were male; the mean age was 53 years, and the mean body mass index was 31.1. In the study population of 13 patients who completed preoperative and postoperative sleep studies, the apnea index decreased from 19.4 to 4.2 (P = .006), the respiratory disturbance index (RDI) decreased from 31.2 to 15.7 (P = .092), and mean lowest oxyhemoglobin saturation increased from 82.3% to 85.0% (P = .581). The RDI fell to 10 or lower in 38.5% of patients and was reduced by at least 50% in 53.8% of the study group. Snoring was significantly reduced in 92.3% of patients (P < .001). These early results suggest that LAUP may be efficacious in the management of OSAS.

Comparison between short-term and long-term post-operative evaluation of sleep apnoea after uvulopalatopharyngoplasty

For a long time uvulopalatopharyngoplasty (UPPP) has been used to treat the obstructive sleep apnoea syndrome (OSAS). The diverse surgical effects, the inadequate understanding of operation effect consistency, the possibility of disease progression, and the few reported papers for long-term evaluation after UPPP aroused our interest in designing this study. Fifteen OSAS patients who had undergone UPPP with pre-operative, initial post-operative and long-term post-operative polysomnographic studies were included in this study. Long-term post-operative polysomnography was undertaken more than five years after surgery. The polysomnographic evaluations included respiratory disturbance index (RDI), duration of saturation SaO2 < 85 per cent (DOS), and the lowest O2 saturation (LOS). Amongst them, 10 patients with initial post-operative RDI reduction > 50 per cent were considered responders. In these responders, the long-term follow-up results of all three parameters showed improvement compared to the pre-operative data. In a comparison between the initial and long-term post-operative sleep study results, LOS and DOS showed no significant difference. However, the long-term post-operative RDI result became significantly worse. More than 80 per cent of all cases had subjective symptomatic improvement in the long-term post-operative evaluation. The subjective improvement after operation is not adequately correlated to the polysomnographic result. We suggest that long-term follow-up for patients after UPPP is necessary.