Surgery For Obstructive Sleep Apnea Syndrome Research Articles

MORPHOLOGICAL CHANGES IN SOFT PALATINE TISSUES STANDING BEHIND OBSTRUCTIVE SLEEP APNEA SYNDROME: GENERAL PATTERN AND ROLE OF HUMAN PAPILLOMA VIRUS

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.

Polysomnography Is an Important Method for Diagnosing Pediatric Sleep Problems: Experience of One Children's Hospital.

In this study, we collected and analyzed polysomnography (PSG) data to investigate the value of PSG in diagnosing sleep problems in children. The results of PSG studies of children (<18 years old) with sleep problems conducted from April 2015 to May 2017 at a children’s hospital in Taiwan were collected and analyzed retrospectively. Data for 310 patients (209 males and 101 females) who underwent PSG were collected. The final diagnoses were as follows: obstructive sleep apnea in 159 (51.3%), snoring in 81 (26.4%), limb movement sleep disorder in 25 (8.1%), hypersomnias in 12 (3.9%), central apnea in 8 (2.9%), enuresis in 7 (2.3%), bruxism in 5 (1.6%), sleep terrors in 5 (1.6%), narcolepsy in 3 (1.0%), sleep seizures in 3 (1.0%), sleep walking in 1 (0.3%), and insomnia in 1 (0.3%). PSG may help detect significant sleep-related problems in children and is useful for making therapeutic decisions regarding children. Obstructive sleep apnea syndrome (OSAS) was the primary sleep problem for most of the children (51.3%); however, only 7.4% of them underwent surgery for OSAS. We therefore suggest that children with sleep problems should undergo PSG.

Long-term efficacy of expansion sphincter pharyngoplasty in obstructive sleep apnea syndrome.

The aim of this study was to analyze both short-term and long-term results of the expansion sphincter pharyngoplasty surgery, which is commonly used in obstructive sleep apnea syndrome (OSAS) and to compare it with objective and subjective methods. Patientswho underwent expansion sphincter pharyngoplasty were included in the study. Polysomnography at postoperative sixth-month, Epworth Sleepiness Scale, and visual analog score of snoring (VAS) were used to assess short-term results. Epworth Sleepiness Scale (ESS) and visual analog score of snoring (VAS) at postoperative third-year were used for long-term results. Sixth-month and third-year data before and after the surgery were compared. Possible complications and morbidity rates related to surgery were evaluated. Of 39 patients, OSAS was assessed as mild in 16 (41%), moderate in 14 (36%), and severe in 9 (23%). Mean age of patients was 43.2 ± 7.5, and 21 were men (54%). According to postoperative six-month PSG data, the apnea hypopnea index (AHI) values decreasedsignificantly from 25.2 ± 8.3 to 11.6 ± 6.9/h, p=0.012. There were decreases in ESS from baseline to 6-month and 3-years from10.4, to 4.4, and 4.4, and VAS scoreschanged from 8.6 to 1.6 and 1.9, p<0.05. No serious complications were observed in patients in the early and late postoperative period. The expansion sphincter pharyngoplasty procedure is an important option for OSAS surgery with long-term effective results and low morbidity and complication rates.

OSAS and upper pharynx surgery: Does basilingual collapsus always rhyme with failure?

ObjectiveDrug-induced-sedation endoscopy (DISE) has proved superior to awake clinical examination for diagnosis of upper-airway obstruction sites and surgical planning. Our question is: does multilevel obstruction on DISE systematically entail failure for surgery limited to the upper pharynx? Material & methodsWe conducted a retrospective single-center study in patients with obstructive sleep apnea syndrome (OSAS) treated by single-level surgery of the upper pharynx (tonsillectomy with or without pharyngoplasty). Preoperative assessment included polysomnography (PSG) and DISE. Surgical efficacy was assessed on postoperative PSG. Treatment response was defined by postoperative apnea-hypopnea index (AHI) <20 events/h with 50% reduction, and cure by AHI <10 (patients with preoperative AHI ≤10 being excluded). Efficacy was compared between groups without (group A) and with basilingual or laryngeal collapsus on DISE (group B). ResultsWe analyzed 63 patients, with mean preoperative AHI 33.8±17.9 events/h. The two groups (A, n=36; B, n=27) were clinically comparable. Postoperative PSG took place at a mean 8.5 ± 11.5 months. The success rate was 66.7% in group A (mean reduction in AHI, 57.3±36.2%) and 59.3% in group B (mean reduction, 53.9±39.2%). Cure rates were respectively 48.5% and 48.1%. There was no statistically significant difference between the two groups (P>0.1). ConclusionsOropharyngeal surgery can alleviate associated obstructive sites found on DISE in the lower pharynx, and step-by-step treatment shows efficacy equal to that of single-step multilevel surgery.

Comparison and intervention of differences in upper airway obstruction in children with OSAS between awake and asleep

Objective:Drug induced sleep endoscopy（DISE） is a useful tool to locate the upper airway obstructions in patients with obstructive sleep apnea syndrome（OSAS）. The goal of our research was to compare the sites, degree and patterns of upper airway obstruction detected by DISE versus endoscopy in awake children. The benefit of DISE-mediated upper airway surgery in pediatric OSAS was evaluated. Method:This is a retrospective case series of children with OSAS who had adenoid hypertrophy（the area where adenoids block the postnaris ≥2/3） and tonsils ≤2 degrees（Friedman classification method） . All children underwent sleep monitoring by pulse oximeter before and after operation. DISE was performed before adenoidectomy in DISE group. If obstruction of oropharynx caused by tonsils was found, tonsillectomy was performed at the same time with adenoidectomy. The children who did not undergo DISE before operation were enrolled in the control group. Differences in the degrees and patterns of upper airway obstruction in the DISE group under wakefulness and drug induction were analyzed. Result:The study included 126 children in DISE group, and 200 children in control group. In the DISE group, 56 cases（44.4%） had grade 2 tonsils, and 70 cases（55.6%） had grade 1 tonsils. The patterns of obstruction at velum, tongue base and epiglottis were significantly different in DISE compared with awake endoscopy（P<0.05）; the patterns of obstruction at adenoid and oropharynx were the same in both techniques. There were significant differences in endoscopy scores between the lateral wall of oropharynx and the tongue base（P<0.05）. DISE revealed 57 （45.2%） cases had grade 2 obstruction in the oropharyngeal level. Among them, 44 cases （34.9%） had tonsils at 2 degrees and 13 cases （10.3%） had tonsils at 1 degrees.. There was an improvement in respiratory disturbance index（RDI） and oxygen saturation nadir in the DISE and control groups 1 year after surgery（P<0.05）, and the RDI improvement was better in the DISE group compared with controls（P=0.04）. Conclusion:DISE is an effective method to evaluate the sites and severity of upper airway obstruction in children with OSAS, which was conductive to make the upper airway personalized surgical plan for patients.

Lateral-Expansion Pharyngoplasty: Combined Technique for the Treatment of Obstructive Sleep Apnea Syndrome.

Introduction Obstructive sleep apnea syndrome (OSAS) is a multifactorial disease characterized by episodes of partial or complete collapse during sleep of different regions of the upper airway. Surgery for OSAS evolved with the introduction of different techniques, considering new surgical concept of reconstruction of the upper airway. Objective To retrospectively evaluate the effectiveness of a new approach aimed at reducing pharyngeal collapse by combining two surgical techniques: lateral and expansion pharyngoplasty. Methods We reviewed the medical records of 38 patients with OSAS undergoing lateral/expansion pharyngoplasty from January 2012 to December 2016. The following data were collected: patient age, gender, and pre- and postoperative body mass index (BMI), Epworth sleepiness scale (ESS) scores, snoring visual analogue scale (VAS) scores, and polysomnography (PSG) results. Results The PSG results showed a significant reduction in the apnea/hypopnea index (AHI) from 22.4 ± 27.3 events/h preoperatively to 13.6 ± 17.9 events/h postoperatively ( p = 0.009), with postoperative AHI reduction greater than 50% in 63.2% of the patients. There was also a significant reduction in the microarousal index (19.5 ± 22.6 vs 11.0 ± 13.4 events/h; p = 0.001) and in the minimum oxygen saturation (82.6 ± 10.3 vs 86.9 ± 11.1; p = 0.007). Conclusions Lateral-expansion pharyngoplasty represents a new surgical strategy for the treatment of OSAS in patients with palatal collapse by combining two different techniques: lateral and expansion pharyngoplasty. The two techniques, performed as a one-stage procedure, led to improvements in excessive daytime sleepiness, snoring, and PSG respiratory parameters by acting on lateral and retropalatal collapse, producing favorable results with good applicability in otolaryngology clinical practice.

"Barbed snore surgery" simulator: a low-cost surgical model.

"Barbed snore surgery" (BSS) represents one of the last innovation for obstructive sleep apnea syndrome (OSAS) surgical management. Although this technique represents an effective and minimally invasive surgery, it is not still widespread in many ENT centers. The aim of our study was to develop an inexpensive surgical simulator useful to expedite the surgical learning curve for BSS in untrained ENT surgeons. The simulator is a simple model composed of a manually shaped silicone palate (3 × 4 × 1cm) fixed on a resin skeleton (21 × 16 × 12cm) using a transparent silicon rubber. The mandible is fixed bilaterally with the aid of two screws allowing for modular inter-incisive distance. Barbed anterior pharyngoplasty (BAPh) was readily performed on the simulator to show the feasibility of this BSS model. All surgical steps were carried out determining a lift and a shortening of the palate as in real surgery. This is the first surgical model that provides a realistic, easily repeatable training in the performance of BSS. Our BSS surgical model is very inexpensive with a cost of approximately 19.25$ dollars and it is manufactured to facilitate a worldwide diffusion of this promising palatal surgery for OSAS.

The Role of Modified Expansion Sphincter Pharyngoplasty in Multilevel Obstructive Sleep Apnea Syndrome Surgery.

Introduction Obstructive sleep apnea syndrome (OSAS) is a sleep disorder caused by an excessive narrowing of the pharyngeal airway that also collapses during inspiration, with an important role played by the lateral pharyngeal wall in the development of the obstruction. Objective To describe our surgical experience with modified expansion sphincter pharyngoplasty (MESP) in the management of lateral collapse in upper airway multilevel surgery. Methods A total of 20 patients with moderate to severe OSAS were recruited in the Ear, Nose and Throat (ENT) Department of the University of Palermo, Italy. All of the enrolled patients refused the ventilatory therapy. The subjects were evaluated for snoring, and daytime sleepiness had a clinical evaluation including collection of anthropometric data and ENT examination and rhinofibroscopy with Müller maneuver. The patients undergoing upper airway multilevel surgery and we selected for MESP the patients with an oropharyngeal transverse pattern of collapse at Müller maneuver. Results In the postoperative assessment, all of the patients reported a reduction in snoring scores and daytime sleepiness. We observed a reduction in the mean apnea-hypopnea index (AHI) of 57.5% of the sample, which decreased from a mean value of 41.7 ( ± 21.5) to 17.4 ( ± 8.9) ( p < 0.05), with a success rate, according to the Sher criteria, of 65%. We observed very few postoperative complications. Conclusion Modified expansion sphincter pharyngoplasty in multilevel surgical therapy preceded by a careful selection of patients has proven to be effective in treating patients with moderate to severe syndromes.

After obstructive sleep apnea syndrome surgery, preoperative, postoperative early and late change of neutrophil / lymphocyte ratio, platelet / lymphocyte ratio and mean platelet volume

Aim: The aim of this study was to investigate the relationship between the severity of obstructive sleep apnea syndrome (OSAS), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR) and mean platelet volume (MPV), preoperative and postoperative early and late levels of these patients surgery related changes were investigated. Methods: A total of 148 patients (22 women, 14.9% and 126 men, 85.1%) who underwent OSA diagnosis and surgical treatment were included in the study. Patients with mild to moderate OSAS [86 (58.1%)], and severe OSAS [62 (41.9%)] patients with apnea hypoapnea index. (OSAS: 5-15 mild OSAS, AHI: 15-30, severe OSAS AHİ 30&gt;) Patients were divided into two groups. Retrospectively, the blood results of these patients were investigated and preoperative, postoperative early and late full blood results were examined. Results: Weight and BMI values were found to be high in the heavy OSAS group. There was no significant difference between mild-moderate OSAS and severe OSAS groups, preoperative, early and late postoperative periods, and between NLR, PLR and MPV values. Intra-group comparison showed an increase in NLR and PLR in the early postoperative period in both groups. There was no difference between the other values. In late postoperative period, NLR levels decreased to preoperative values while PLR levels were higher than preoperative values. Conclusion: The similarity of NLR, PLR, and MPV values between the mild-moderate and severe OSAS groups as a marker of systemic inflammation and the fact that airway obstruction was remained unchanged suggests that oxidative stress and systemic inflammation in this disease are due to a variety of factors besides airway obstruction.

Distraction osteogenesis as a treatment of obstructive sleep apnea syndrome: A systematic review.

Background:To conduct a systematic review to answer the clinical question “What are the effectiveness of mandibular distraction osteogenesis (MDO) and its complications to treat patients with obstructive sleep apnea syndrome (OSAS)?”.Methods:A systematic search including a computer search with specific keywords, reference list search, and manual search were done. Relevant articles on MDO were assessed and selected in 3 rounds for final review based on 5 predefined inclusion criteria and followed by a round of critical appraisal. Different types of distraction and their treatment outcomes of OSAS were recorded with standardized form and analyzed.Results:Twelve articles were included in the final review. A total of 256 patients aged 7 days to 60 years were treated with either external or internal MDO, with a mean follow-up period of 6 to 37 months. The average distraction distance of 12 to 29 mm was achieved with various distraction protocols. The success rate for adult patients was 100%, and cure rates were ranged from 82% to 100%. The definition of success or cure for OSAS in children or infants was not defined. Therefore, there were no clearly reported success or cure rates for children/infants in the included studies. However, all studies reported that these patients showed significant improvement in OSAS, with many of them who avoided tracheostomy or had the tracheostomy decannulated. The complication rates were ranged from 0% to 21.4%, with most being from local wound infections or neurosensory disturbances.Conclusion:This systematic review showed that MDO was effective in resolving OSAS in adults with retrognathic mandible. MDO also showed promising results in infants or children with OSAS. From the results of this systematic review, we recommend to define the criteria of success or cure for OSAS surgery in children and infants. We also recommend setting up randomized controlled trials to compare MDO with traditional maxillomandibular advancement surgery for OSAS patients and to provide a better evidence on the success and complication rates of the techniques.

Comparative Analysis of Lateral Pharyngoplasty and Uvulopalatopharyngoplasty Techniques With Polisomnography and Epworth Sleepiness Scales

Snoring is caused by the vibration of structures of the oral cavity, such as the soft palate, uvula, tonsils, base of the tongue, epiglottis, and lateral pharyngeal walls. When these structures collapse and obstruct the airway, apnea occurs. Obstructive sleep apnea syndrome (OSAS) is characterized by repeated periods of upper airway obstruction, a decrease in arterial oxygen saturation, and interrupted sleep. The prevalence of OSAS is 1% to 5% in men and 1.2% to 2.5% in women. Crucial factors in deciding the surgical approach include a detailed ear-nose-throat examination, Muller maneuver, sleep endoscopy, and apnea hypopnea index scores. Accepted treatments include continuous positive airway pressure (CPAP), surgeries of the base of the tongue and/or palate, and multi-level surgeries. It, however, is important to continue to evaluate the efficacies of such procedures. The authors evaluated the outcomes of 23 patients who underwent surgery for OSAS, using preoperative and postoperative polysomnography (PSG) and the Epworth sleepiness scale (ESS). The results were compared before and after surgery. In all, 14 patients had lateral pharyngoplasty and 9 had uvulopalatopharyngoplasty (UPPP). The PSG and Epworth scale values were significantly lower in both groups, postoperatively. Patients indicated that their quality of life had improved. In conclusion, the surgeries were successful. In line with the literature, our results indicate that lateral pharyngoplasty and UPPP can be used in appropriate patients. Longer-term studies on more patients will provide more detailed information in the future.

Objective and Subjective Outcomes Following Maxillomandibular Advancement Surgery for Treatment of Patients With Extremely Severe Obstructive Sleep Apnea (Apnea-Hypopnea Index >100)

It is important for patients and treating clinicians to know whether maxillomandibular advancement (MMA) surgery is effective when treating patients with obstructive sleep apnea syndrome (OSAS) and an extremely high apnea-hypopnea index (AHI) score. The purpose of this study was to evaluate objective and subjective treatment outcomes after MMA surgery for the treatment of OSAS in patients with a preoperative AHI score higher than 100. This retrospective study included all patients who underwent MMA surgery for OSAS by members of the Department of Oral and Maxillofacial Surgery, QEII Health Science Centre (Halifax, Nova Scotia, Canada) from November 1996 through February 2014. Objective data were available in the form of polysomnographs (PSGs) obtained before and a minimum of 6 months after surgery. Patients completed a self-administered questionnaire before and after surgery regarding snoring, witnessed apneas, continuous positive airway pressure (CPAP) use, daytime somnolence, and overall satisfaction. Two hundred sixty-five patients had MMA surgery, of which 13 had pre- and postoperative PSGs. PSGs showed a mean preoperative AHI score of 117.9 and a mean postsurgical AHI score of 16.1 (P < .001). Pre- and postoperative questionnaires were available for 9 patients. After surgery, 7 patients denied having any daytime sleepiness and 2 patients reported minimal daytime sleepiness. The mean preoperative Epworth Sleepiness Scale score was 12.9 (standard deviation [SD], 5.5), whereas the postoperative mean score was 5.0 (SD, 4.1; P = .004). Before surgery, all 9 patients reported loud snoring and 8 reported witnessed apneas. After surgery, 2 patients reported minimal snoring and only 1 patient continued to have witnessed apneas. Six patients used CPAP preoperatively and only 1 patient continued to use CPAP after surgery. The results of this study suggest that MMA surgery for treatment of extremely severe OSA can be a highly successful 1-stage surgery, which eliminates the use of CPAP, improves subjective outcomes, and considerably decreases the AHI score.

Understanding Obstructive Sleep Apnea Syndrome in Children

Obstructive sleep apnea syndrome (OSAS) is relevant to pediatric anesthesia and is often encountered in adenotonsillectomy (A&T), the most common pediatric surgery and first-line treatment for OSAS. End-organ effects of OSAS are widespread and include pulmonary and cardiovascular complications, neurocognitive and behavioral disruption, and metabolic and inflammatory derangements. Co-existing obesity and asthma are commonly encountered. OSAS increases risk for postoperative respiratory complications causing death or anoxic brain injury. While preoperative OSAS diagnosis is preferred, anesthesia and surgery societies have not adopted emerging diagnostic technologies. Guidelines for identifying which children may undergo ambulatory versus in-patient surgery, anesthetic technique, and postoperative monitoring are lacking. Risk factors for respiratory complications post A&T include patients <3 years, suspected/diagnosed severe OSAS, and co-morbidities. Perioperative use of NSAIDs in children undergoing A&T remains controversial. Dexamethasone and alpha-2 agonists are preferred in children with OSAS undergoing A&T surgery, whereas neostigmine should be avoided. The ideal opioid for use in these children is unknown. However, prescribing postoperative codeine presents serious risk of perioperative cardiac arrest, particularly in those with severe OSAS complicated by obesity. Opioid metabolic pathway overlap with codeine is a concern. Consensus guidelines are required in pediatric anesthesia to improve outcomes in OSAS.

Impact of Multilevel Surgical Treatment on Mean Platelet Volume in Patients With Obstructive Sleep Apnea Syndrome.

Mean platelet volume (MPV) is a potential marker of platelet reactivity. Increased MPV levels are shown to be the predictor of cardiovascular diseases, hypertension, and stroke. Previous studies demonstrated increased MPV levels in patients with obstructive sleep apnea syndrome (OSAS). The aim of this study was to examine the impact of 1-stage multilevel surgical treatment on MPV levels in patients with OSAS. Preoperative and postoperative 6-month hematologic parameters as well as polysomnographic findings of 42 patients, who underwent 1-stage multilevel surgery for treatment of moderate or severe OSAS, were compared. In the comparisons of preoperative and postoperative apnea-hypopnea index (AHI) and MPV values, statistically significant decreases were detected There was a significant positive correlation between the decrease in mean AHI and decrease in MPV levels. One-stage multilevel surgery targeting the obstruction at the retropalatal and tongue-base levels was found to be effective in decreasing AHI and MPV. Mean platelet volume may be a new index to indicate the success of OSAS surgery.

Surgery for obstructive sleep apnea

Nasal continuous positive airway pressure (CPAP) is considered an ideal treatment for treating Obstructive Sleep Apnea Syndrome (OSAS), due to its being conservative and reversible; however, there is a poor rate of adherence in its long-term use. Surgery can significantly complement those cases where CPAP is not tolerated. Surgery for OSAS must be carried out taking into account the degree of obstructive apnea, the place of greatest obstruction and the experience of the medical team. The more severe the OSAS, the more aggressive the surgical therapy can be. The place of obstruction must not be considered in a simplistic way, in which only one place of obstruction is defined, but as a general alteration of the airway where the surgeon must act in order to carry out an effective remodelling. This paper describes different types of surgery and their efficacy in OSAS according to the anatomical area involved (nose, adenoidal surgery, tonsils, soft palate, base of the tongue, hypopharynx and bimaxillary protrusion). The scientific evidence shows that at present reconstructive surgery of the airway competes effectively with medical treatment.

Selected surgical managements in snoring and obstructive sleep apnea patients

SummaryBackgroundThe diagnostic process and the surgical procedures in patients with snoring and obstructive sleep apnea syndrome (OSAS) are crucial. The aim of this study was to assess the efficacy of surgical treatment in snoring and OSAS patients.Material/MethodsA precise laryngological examination and screening polysomnography (Poly-Mesam) were performed in all patients with mild, moderate and severe OSAS before and 6 months after surgery. The patients completed questionnaires concerning their complaints. We included patients qualified to septoplasty, laser-assisted uvulopalatoplasty (LAUP), uvulopalatopharyngoplasty (UPPP) and radiofrequency-induced thermotherapy of the tongue base (RITT). Outcome evaluation of surgery was performed on the basis of data received from follow-up laryngological examinations, selected parameters obtained from the Poly-Mesam test and follow-up questionnaires.ResultsIn most cases we observed improvement, defined as decreasing some sleep parameters, such as a respiratory disturbance index (RDI), by more than 50%, decreasing the loudness of snoring, decreasing the number of hypopneas, and obtaining better blood saturation values. After UPPP we noticed changes in retropalatal space, soft palate dimensions and uvula-posterior pharyngeal wall distance. In the postoperative period we did not observe severe complications. In some cases we found short-lived palatal deficiency after UPPP. Patients after RITT experienced discomfort and throat pain lasting from 2 to 4 days. In 2 patients we observed swelling of the tongue base, which decreased after few days.ConclusionsSurgery in OSAS contributes to normalization of some sleep parameters. The majority of patients experienced improvement after surgery.

Statistical model for postoperative apnea–hypopnea index after multilevel surgery for sleep-disordered breathing

The objective of the study was to formulate a statistical model for postoperative apnea-hypopnea index (AHI) 3 and 12 months after multilevel surgery using the predictors preoperative AHI, body mass index (BMI) and age. The study design was a prospective cohort study. Data of 144 patients were collected prospectively 3 and 12 months after multilevel surgery for obstructive sleep apnea syndrome (OSAS) or upper airway resistance syndrome with excessive daytime sleepiness. The primary endpoint postoperative AHI and the secondary endpoint success according to the Sher criteria (postoperative AHI <20 h and >50% reduction of preoperative AHI) were modeled with multiple linear and logistic regression using the predictors preoperative AHI, BMI, age and the indicator whether the patient had undergone a tonsillectomy. Preoperative AHI and tonsillectomy had a highly significant positive influence on postoperative AHI after 3 months, whereas the influence of preoperative BMI was only marginally significant but numerically rather large. Age was not a significant decisive factor. The success according to the Sher criteria was highly significantly determined by the circumstance whether the patient had undergone a tonsillectomy, but not by the other predictors preoperative BMI or age. The responder rate with and without tonsillectomy was 58 and 19%, respectively. The odds ratio to be a responder if a tonsillectomy was conducted was 5.7. This study provides statistical models predicting postoperative AHI and success according to the Sher criteria after multilevel surgery for OSAS.

Reporting Results of Obstructive Sleep Apnea Syndrome Surgery Trials

Obstructive sleep apnea syndrome surgery studies largely evaluate single procedures or procedure combinations in case series designs, but it can be difficult to compare results across studies. The authors present a standardized format for presentation of surgical study results to facilitate pooled analyses and subgroup analyses. The format includes thorough characterization of baseline subject characteristics and the use of outcome measures that reflect the spectrum of obstructive sleep apnea and its consequences. As the apnea-hypopnea index is the most common, albeit controversial, primary outcome measure in obstructive sleep apnea syndrome surgery studies, the authors propose analysis and reporting standards to facilitate understanding its role as an outcome measure. Because surgical outcomes vary according to subject characteristics, investigators should also evaluate the potential association between baseline subject characteristics and outcomes.

Low-Temperature Bipolar Radiofrequency Ablation (Coblation) of the Tongue Base for Supine-Position-Associated Obstructive Sleep Apnea

Objective: To assess the effectiveness of low-temperature bipolar radiofrequency ablation for Coblation of the tongue base in the multilevel management of supine-position-associated obstructive sleep apnea syndrome (OSAS). Study Design and Setting: A retrospective analysis of the data of 16 subjects undergoing uvulopalatopharyngoplasty and tongue base Coblation. The efficacy of the procedure was investigated on the basis of polysomnographic results. Results: The success rate was 62.5% in 16 patients who underwent surgery for OSAS, with decreases in the mean Apnea Hypopnea Index of 20.1–8.9. The success rate was separately evaluated according to the subjects’ posture. A rate of 87.5% was found for the supine position, while the rate was 56.6% in non-supine positions. The minimum postoperative O₂ saturation was significantly increased for REM and non-REM stage 3 sleep rates. Conclusion: It is important to evaluate the relation of the disease to the body position in sleep apnea subjects. Coblation of the tongue base is an applicable method of therapy for patients who have sleep apnea that is more marked in the supine position.

Functional nasal surgery in the treatment of obstructive sleep apnea

The study included 22 males with significant decrease in nasal patency, at age of 44+/-7 yrs with body mass index 28.9+/-3.8 kg/m2, diagnosed with obstructive sleep apnea syndrome (OSAS) by polysomnography. All patients underwent functional, corrective nasal surgery. In one patient an infection in the wound occurred. Postoperatively 19 (86%) patients reported significant subjective improvement. With regard to polysomnography, one patient was cured and in another one a decrease of AHI to more than 50% of baseline was found. In 6 (27.3%) patients AHI rose from 33.2+/-13 to 53.6+/-21.2. Nasal surgery in OSAS shows limited effectiveness. Because of multilevel decrease in airway patency, some of the patients may need a step-wise approach to surgical treatment.