Underwent Uvulopalatopharyngoplasty Research Articles

Our experience in the surgical treatment of Obstructive Sleep Apnea

Background: Obstructive Sleep Apnea (OSA) is a sleep-related breathing disorder, leading to decreased quality of life, increased risk of cardiovascular morbidity and mortality, increased frequency of automobile accidents. Continuous positive airway pressure (CPAP) remains the first line of treatment for OSA. Many patients are unwilling or incapable to tolerate the treatment and therefore turn to surgical options to alleviate symptoms and sequela of the disease. Аim: To present our experience in the surgical treatment of OSA. Materials and Methods: 50 patients (48 male / 2 female) underwent surgical treatment for OSA in our clinic for a period of 10 years. Subjective complaints were evaluated by interview of the patient and partner pre- and postoperatively, with key factors studied being snoring level (visual analogue 1–10) and Epworth Sleepiness Scale (ESS). Objective data were Body Mass Index (BMI), nasal endoscopy, pre and postoperative polysomnographic data, rhinomanometry, Mallampati score, diagnostic imaging of the nose and sinuses. Results: The mean BMI of the patients was 29.8± 3.4. 21 patients had nasal obstruction for which they underwent surgical treatment. 5 patients had micro or retrognathia. 37 Pateints had a Mallampati score of 3 and 13 of 4. All 50 patients underwent Uvulopalatopharyngoplasty (UPPP) and 6 patients also had Radiofrequency tongue base reduction. There were no serious complications. Subjective improvement in the severity of the symptoms was obtained in 88% (44) of patients. Objective success was obtained in 56% (28) of the patients. Conclusions: Surgical treatment of OSA leads to a significant subjective improvement in the severity of symptoms and acceptable objective results. For maximal results a multidisciplinary approach is required for the complex treatment of OSA.

Influence of modified uvulopalatopharyngoplasty on body weight and quality of night sleep in patients with low compliance to CPAP therapy

Topicality: Obstructive sleep apnea syndrome (OSAS) is one of most wide-spread sleep disorders worldwide leading to the strong decrease in the quality of life, occupational and social efficiency of the patients. Golden standard for the management of OSA included CPAP therapy. However, it creates significant inconvenience for patient and has low compliance. Surgical treatment is considered as an alternative but still lucks unified approaches and quality scientific data. Methodology: Study involved 37 patients with II stage OSA caused by defects of soft palatine and uvula previously incompliance to CPAP that underwent uvulopalatopharyngoplasty (UPPP) by advanced low traumatic technic. Respiratory polygraphy (RP) was performed before (b) and after (a) operation to estimate the efficacy of procedure. Statistical analysis included body weight (BW), BMI, tital number of apnea episodes (NAE), total number of hypopnea episodes (NHE), percentage of normal sleep (NS) with average for indicators with normal distribution, median values, difference between the groups was evaluated by Wilcoxon signed-rank test with p-value=0.05. Results: Average age of the patients was 45(SD=13) years. The results were next: BMI(b)=30,2 (SD=2,7); BMI(a)=28,83 (SD=2,96); BW(b)=91,35 (SD=10,21); BW(a)=86,59 (SD=9,86); median NAE(b)=39, median NHE(b)=15; NS(b)=85,32% (SD=10,02); median NAE(a)=18, median NHE(a)=7; NS(a)=96,39% (SD=3,98). Advanced low traumatic UPPP led to the positive changes in of all indicators with high statistical significance (p<0,01). Conclusions: Advanced UPPP has shown positive effects on the quality of night sleep and respiration in patients incompliant to CPAP therapy. In addition UPPP had led to decrease in bode weight but this point should be followed up longer.

Readmission after Adult Uvulopalatopharyngoplasty: A Population-Based Inpatient Cohort Study in Taiwan.

To investigate readmissions among adult inpatients who underwent uvulopalatopharyngoplasty (UPPP) in Taiwan. Population-based survey. Retrospective study with the National Health Insurance Database. All cases of inpatient adult UPPP (age >20 years) from 1997 to 2012 were identified through International Classification of Diseases, Ninth Revision, Clinical Modification. Factors associated with readmission within 30 days after surgery were analyzed. A total of 38,839 adults with UPPP were identified (mean age, 39.3 years; men, 73.7%). The incidence of UPPP was 14.6 per 100 000 adults, which increased from 1997 to 2012 (6.7 to 16.7 per 100,000, Ptrend < .001). The rates of readmission for any reason, readmission for bleeding, reoperation for bleeding, and 30-day mortality were 4.2%, 1.7%, 1.0%, and 0.14%, respectively. Young age increased the risk of reoperation for bleeding, and old age increased the risk of readmission for any reason and mortality. Men had an increased risk of readmission and reoperation. Hypertension was associated with an increased risk of readmission for any reason (odds ratio [OR], 1.29; 95% CI, 1.10-1.51), bleeding-related readmission (OR, 1.89; 95% CI, 1.52-2.36), and reoperation (OR, 2.47; 95% CI, 1.84-3.30). Concurrent hypopharyngeal surgery was associated with an increased risk of readmission for any reason (OR, 1.34; 95% CI, 1.07-1.66) and bleeding-related readmission (OR, 1.69; 95% CI, 1.25-2.27). Finally, the use of steroids was associated with an increased risk of bleeding-related readmission and reoperation. The incidence of adult UPPP increased from 1997 to 2012 in Taiwan. Age, sex, comorbidity, concurrent hypopharyngeal surgery, and drug administration were associated with readmission after inpatient UPPP.

Nocturia Improvement With Surgical Correction of Sleep Apnea.

PurposeTo evaluate changes in nocturia after surgical correction of obstructive sleep apnea (OSA).MethodsA total of 66 patients were included in the present study. All had been diagnosed with OSA syndrome by polysomnography and underwent uvulopalatopharyngoplasty (UPPP). Preoperative and postoperative lower urinary tract symptoms (LUTS), quality of life (QoL), and nocturia episodes were evaluated using the International Prostate Symptom Score (IPSS) and overactive bladder symptom score (OABSS) questionnaires. Three months postoperatively, telephone interviews were performed to determine the success of surgery, current LUTS, and nocturia episodes. Patients were divided into surgical success and failure groups. Surgical success was defined as snoring decrease more than 50% based on the patient’s subjective judgment.ResultsThe response rate was 56% and success rate was 73%. In all patients, nocturia episodes significantly decreased from 1.7±1.1 to 0.8±1.2 (P=0.002). Mean IPSS score, OABSS score, and QoL scores were also significantly improved. The success group showed a significant decrease in nocturia episodes, and total IPSS, OABSS, and QoL scores. However, the failure group did not show significant changes in all parameters.ConclusionsOSA correction improved nocturia as well as other LUTS. These improvements were not observed in the failure group. This study shows that OSA is a cause of nocturia and that other LUTS and nocturia can be improved by surgical correction of OSA.

Effect of intravenous vitamin C on postoperative pain in uvulopalatopharyngoplasty with tonsillectomy.

Postoperative pain is a common problem in hospitals. Adults undergoing uvulopalatopharyngoplasty (UPPP) with tonsillectomy experience an unacceptable level of intense postoperative pain, especially during the first 24 h after surgery. This study investigated the analgesic effects of vitamin C in patients undergoing UPPP and tonsillectomy. This study was done on forty patients that were evaluated in a randomised double-blinded clinical trial. Patients included in the study were within the age range of 25-50 years with BMI<35, physical status I,II according to the American Society of Anesthesia (ASA) and who underwent uvulopalatopharyngoplasty and tonsillectomy. Patients with epilepsy, BMI>35, any neuropsychiatric disorders, a history of chronic pain, liver and/or renal disease, drug allergy, and drug abuse were excluded from the study. All patients underwent the same method of anaesthesia and surgical procedure. During the first 30 min after the beginning of the surgery, group C (vitamin C) received infusion of 3 g vitamin C in 500 mL of Ringer and group P received 6 mL normal saline in 500 mL of Ringer. Measurements of systolic blood pressure, diastolic blood pressure, mean arterial blood pressure and heart rate were recorded before and during anaesthesia and at intervals of 0,15,30 and 60 min after extubation. Pain severity was recorded according to VAS score at intervals of 0 (recovery room), 6, 12 and 24 h after the procedure, request for analgesic drugs (iv paracetamol or pethedine) according to total number of times of analgesic request and time of the first dose of analgesic use and dose of pethidine were also recorded by questionnaire. There was a significant difference in evaluations for mean pain severity between the two groups at recovery room, 6, 12 and 24 h after surgery (P-value = 0.001). There was a significant difference in mean times that patient requested an analgesic, time of first dose of analgesic and pethidine dose between the two groups (P-value< 0.05). There was no significant differences in measurements of systolic blood pressure, diastolic blood pressure, mean arterial blood pressure and heart rate in different times between the two groups (P-value> 0.05). Blood loss was similar in the two groups (P-value> 0.05). According to this study, administration of vitamin C 3 g IV intraoperative reduced postoperative pain without increased side-effects in patients undergoing UPPP and tonsillectomy.

Clinical Analysis of Drug‐Induced Sleep Endoscopy for the OSA Patient

Objectives: Determine if performing drug-induced sleep endoscopy (DISE) and trans-oral robotic surgery (TORS) for the treatment of obstructive sleep apnea (OSA) is associated with improved outcomes and acceptable complication rates when compared to traditional surgical procedures without DISE. Methods: A retrospective, nonrandomized chart review. Patients with OSA who underwent uvulopalatopharyngoplasty (UPPP) in 2011 were compared with a prospective, nonrandomized group of patients with OSA who underwent DISE with other indicated procedures from 2012-2013 at a major tertiary care center. The pre- and postoperative apnea-hypopnea index (AHI), pre- and postoperative Epworth Sleepiness Scale (ESS), and major complication rate were compared. Results: Forty patients underwent UPPP without DISE. These patients showed a significant reduction in AHI –20.1 ( P = .001) and a complication rate of 3% ( P = .001). There was no significant change in ESS –2.2 ( P = .734). Fifty-nine patients underwent DISE with other indicated procedures. These patients showed a significant reduction in AHI –21.4 ( P = .001) and a complication rate of 34.7% ( P = .001). There was no significant difference in ESS +0.1 ( P = .734) or AHI ( P = .092) between the 2 groups. Conclusions: There was no significant difference in AHI or ESS in patients who underwent UPPP without DISE compared to patients who underwent DISE with other indicated procedures including TORS. Patients who had DISE and TORS surgical interventions for OSA demonstrated an increase in the rate of major complications.

The relationship between structural/MHC changes in upper airway palatopharyngeal muscle morphology and obstructive sleep apnea/hypopnea syndrome

The aim of this study is to explore the relationship between structural/MHC changes in upper airway palatopharyngeal muscle morphology and obstructive sleep apnea/hypopnea syndrome. Palatopharyngeal muscle specimens were taken from 51 patients with obstructive sleep apnea hypopnea syndrome (OSAHS) who underwent uvulopalatopharyngoplasty (UPPP) resection. Patients were divided into light, medium and severe in terms of the severity of their OSAHS. There were 17 patients in each severity group. Palatopharyngeal muscle specimens were also taken from 17 patients suffering from chronic tonsillitis for comparison as the control group. All specimens were stained using Masson and observed for structural changes, especially in muscle fiber morphology, density and arrangement, as well as intermuscular connective tissues, under light microscopy. All specimens were also analyzed for MHC-I, MHC-IIa and MHC-IIb phenotype and protein expression differences using mRNA quantitative reverse transcription polymerase chain reaction (RT-PCR) and immunofluorescence staining. The results from each group were then statistically analyzed using semi-quantitative analysis. Light microscopy with Masson staining revealed that in the control group, the muscle fibers are closely connected and arranged neatly. In specimens from patients suffering from OSAHS, the palatopharyngeal muscle fibers are larger with obvious hypertrophy and there was an increase in elastic fibers. The mucosal lamina propria was thickened, and the density of muscle fibers was reduced. Muscle fibers are not neatly arranged and degeneration was observed. The amount of muscular pathology and fibrosis corresponds to the severity of disease in the patients. In patients with severe OSAHS, the proportion of collagen to muscle fibers was increased significantly. Immunofluorescence results reveal that there were significantly more fast muscle fibers and less slow muscle fibers in the study group than the control group. mRNA quantitative reverse transcription polymerase chain reaction (RT-PCR) revealed similar results, i.e., the proportion of MHC-II palatopharyngeal muscle fibers is higher in the study group than the control group, and increases with the severity of OSAHS. Pathological change occurs in both the collagen and muscle of OSAHS patients and corresponds to the degree of severity of OSAHS. Pathological change in palatopharyngeal muscle tissues is therefore, likely to be related to the occurrence and development of OSAHS. The increase in the proportion of the MHC-1I type fibers in OSAHS patients is likely to have an effect on the amount of airway support conferred by the muscle. This is likely the reason behind the lack of clinical improvement in some patients with severe OSAHS despite surgical treatment.

Immediate complications related to anesthesia in patients undergoing uvulopalatopharyngoplasty for obstructive sleep apnea

To analyze and assess the perioperative risks and complications in patients receiving general anesthesia undergoing surgery for obstructive sleep apnea (OSA). Retrospective chart review of patients with documented OSA who underwent uvulopalatopharyngoplasty (UPPP) with or without septoplasty for OSA between January 2009 and January 2010 at a specific institution. Anesthesia, operative, clinical, and postoperative/recovery nursing records were collected and reviewed for predetermined complications and risk factors. Chart review was performed via electronic medical records, reviewing the perioperative course of 32 patients undergoing UPPP as identified by Current Procedural Terminology coding. Perioperative, clinical, and anesthetic records were reviewed for any complications and risks, defined as any adverse event delaying surgical progress or recovery along with any additional risk to patient safety. Criteria included interventions beyond those involved in undergoing routine general anesthesia. This included difficult intubation, reintubation, postoperative pulmonary edema, postoperative desaturations, and/or need for continuous positive airway pressure. The data obtained were stratified into results for intubation and special equipment needed along with airway visibility and intubation technique, reintubation, induction and supplemental drugs, neuromuscular blockade, neuromuscular blockade reversal, pain medications, body mass index, and overall anesthesia risk. Thirty-two patients were reviewed with no severe adverse events such as reintubation, prolonged intubation, or postoperative pulmonary edema. Patients who were difficult to intubate or required nasal/oral airways failed to show any adverse outcomes. Patients undergoing surgery for OSA are considered to be at increased risk of complications. Review of 32 patients failed to show any life-threatening risks or complications.

Lingual artery CTA-guided midline partial glossectomy for treatment of obstructive sleep apnea hypopnea syndrome

Conclusion: Midline partial glossectomy guided by lingual artery computed tomographic angiography (CTA) demonstrated a satisfactory safety profile and therapeutic effect for patients with obstructive sleep apnea hypopnea syndrome (OSAHS) due to tongue hypertrophy. Objective: To evaluate the efficacy and safety profile of midline partial glossectomy guided by lingual artery CTA for the treatment of OSAHS due to tongue hypertrophy. Methods: Sixty-seven OSAHS patients with a narrowed airway at the hypopharyngeal region due to tongue hypertrophy underwent uvulopalatopharyngoplasty (UPPP) in combination with midline partial glossectomy. The operation zone was determined according to the anatomic measurement obtained from lingual artery CTA and the resected region was much larger than with conventional midline partial glossectomy. Postoperative complications were closely monitored and sleep condition was followed up for more than 6 months and re-evaluated by polysomnography (PSG). Results: All the operations proceeded uneventfully without any complications, demonstrating a satisfactory safety profile. After a follow-up period of more than 6 months, of the 67 patients undergoing the procedure, 24 were cured and 34 exhibited markedly improved sleep, whereas 9 showed little or no improvement, giving an effectiveness rate of 86.6% for the operation.

Effect of dexmedetomidine on stress responses during extubation in patients undergoing uvulopalatopharyngoplasty

To observe the effect of dexmedetomidine hydrochloride on stress responses during extubation in patients undergoing uvulopalatopharyngoplasty (UPPP). Eighty-six scheduled for UPPP under general anesthesia were randomly divided into dexmedetomidine group (group D, n = 50) and control group (group C, n = 36). All patients were transported into post anesthesia care unit (PACU) after surgery and maintained sedation and analgesia by infusing propofol and sufentanil. Patients in group D were administrated dexmedetomidine 0.5 µg/kg, group C were administrated equivalent volume of normal saline. Both groups were treated with mechanical ventilation 6 - 24 h before extubation. Recovery time, the dosage of sedative and analgesic drugs and side effects were recorded. There were no significant differences between two groups in recovery time (P > 0.05). The dosage of propofol and sufentanil in group D were respectively (785 ± 65) mg, (176 ± 10) µg, significantly less than that in group C (950 ± 101) mg, (209 ± 14) µg (P < 0.05). side effects in group D were significantly less than that in group C (P < 0.01). Dexmedetomidine hydrochloride could efficiently restrain the stress response around tracheal extubation, reduce postoperative complications in patients undergoing UPPP.

Immunohistochemical and histomorphometric study of human uvula innervation: a comparative analysis of non-snorers versus apneic snorers

The objective of this study was to verify a possible correlation between the etiology of uvulopalatal ptosis and decrease in palatopharyngeal muscle tone, due to a reduction of the number of nerve fibers in surgical specimens obtained from snoring patients. DESIGN/SETTING OF THE STUDY: We have designed a comparative retrospective, case-control, double-blind, immunohistochemical and histomorphometric study of human uvula innervation in 51 apneic snoring patients who underwent uvulopalatopharyngoplasty (UPPP) and 47 normal subjects collected in a 5-year-long period in the Departments of Otolaryngology of Desio and Forlì Hospital, Italy. Case study was chosen in patients who underwent UPPP, variably associated with other disobstructive surgical procedures for treatment of obstructive sleep apnea syndrome, classified according to current clinical, polysomnographic, endoscopic, and imaging criteria. Control subjects were recruited at the Institute of Legal Medicine, University of Milan, according to strong inclusion and exclusion criteria. The main outcome measure of the study was the number of nerve fibers in the patients' uvula evaluated histologically and repeated two times by two different people, in all the areas of the specimens. Finally, we correlated the area of the histological section with the number of fibers contained therein. The number of nerve fibers varied from a minimum of 58 to a maximum of 163 in normal subjects. In the snoring patient population, the number of nerve fibers varied from a minimum of 22 to a maximum of 126 (statistically significant difference, p < 0.0001). In conclusion, our results direct toward a clear neurogenetic predisposition to uvulopalatal ptosis, marked ab initio by a lower set of motor nerve fibers, which may be the initial stage of another subsequent morphological and functional abnormality.

Persistent Hypersomnolence in an Elderly Male

A 73-year-old male presents with hypersomnolence and witnessed pauses in breathing during sleep lasting 30–60 seconds. He was diagnosed with obstructive sleep apnea in 1996 and underwent uvulopalatopharyngoplasty (UPPP). His symptoms re-emerged 2 years later. Multiple sleep studies done since then demonstrated Cheyne Stokes breathing. He was treated with continuous positive airway pressure (CPAP), bilevel PAP (with and without backup rate), and/or supplemental oxygen but he continued to have unabated diurnal hypersomnolence and his wife noted incomplete resolution of pauses in breathing. He had history of atrial fibrillation, coronary artery disease, and permanent pacemaker placement. A representative tracing from his diagnostic polysomnogram is shown below (display range 240 seconds). Which of the following treatments is likely to be MOST effective in treating his sleep disordered breathing? Beta blockers Adaptive Servoventilation Automatically adjusting PAP Theophylline Supplemental CO2 Answer B Adaptive servoventilation

One-phase management of severe obstructive sleep apnea: Tongue base reduction with hyoepiglottoplasty plus uvulopalatopharyngoplasty

To describe the results of a 1 phase surgical procedure for the treatment of severe obstructive sleep apnea (OSA) attributable to tongue base obstruction. A retrospective nonrandomized study at S Orsola Malpighi University Hospital of Bologna, Italy. Ten male patients affected by severe OSA (mean apnea/hypopnea index [AHI] of 54.7), underwent uvulopalatopharyngoplasty (UPPP) associated with tongue base reduction and hyoepiglottoplasty (TBRHE). The indications to this surgical procedure were based on the presence of hyolingual abnormalities and absence of craniofacial deficiencies determined by preoperative assessment. Mean AHI decreased from 54.7+/-11.5 to 9.4+/-5.4 whereas the mean low SaO2 value went from 77%+/-6.2 to 90.7%+/-3 and the time of sleep with SaO2<90% improved from 53%+/-17.2 to 7.3%+/-8. The overall success rate was 100%. TBRHE is an effective and safe treatment in patients with severe OSA attributable to tongue base obstruction and in absence of craniofacial deficiencies.

Abnormal palatopharyngeal muscle morphology in sleep-disordered breathing

The aim of the present study was to investigate whether histopathological changes can be detected in two soft palate muscles, the palatopharyngeus and the uvula, in 11 patients with long duration of sleep-disordered breathing (SDB). Muscle samples were collected from patients undergoing uvulo-palatopharyngoplasty (UPPP). Reference samples from the corresponding areas were obtained at autopsy from five previously healthy subjects. Muscle morphology, fibre type and myosin heavy chain (MyHC) compositions were analysed with enzyme-histochemical, immunohistochemical and biochemical techniques. The muscle samples from the patients, and especially those from the palatopharyngeus, showed several morphological abnormalities. The most striking findings were (i) increased amount of connective tissue, (ii) abnormal variability in fibre size, (iii) increased proportion of small-sized fibres, (iv) alterations in fibre type and MyHC compositions, (v) increased frequency of fibres containing developmental MyHC isoforms. Our findings point towards a pathological process of denervation and degeneration in the patient samples. Conclusively, the morphological abnormalities suggest a neuromuscular disorder of the soft palate in SDB patients.

Fiberoptic nasopharyngolaryngoscopy for airway monitoring after obstructive sleep apnea surgery

Purpose: This study evaluated the upper airway characteristics in the early postoperative period after reconstructive surgery for obstructive sleep apnea (OSA). Methods: During a 24-month period, the upper airway of patients who underwent uvulopalatopharyngoplasty (UPPP) with genioglossus advancement (GA) or hyoid myotomy (HM) or maxillomandibular advancement (MMA) were evaluated with fiberoptic nasopharyngolaryngoscopy (NPG) preoperatively and 24 to 72 hours postoperatively. Results: NPG was performed on 271 patients. One hundred seventy-three patients had UPPP with GA or HM, and the remainder had MMA. All of the patients who underwent UPPP with GA or HM were found to have varying degrees of soft tissue edema involving the soft palate and the tongue base. The patients who underwent tonsillectomies and UPPP with GA or HM had greater soft palate/pharyngeal wall edema. In contrast, patients who underwent MMA had minimal edema involving the soft palate and the base of tongue, but diffuse lateral pharyngeal wall edema throughout the upper airway was identified. Eighteen of the MMA patients had ecchymosis and edema involving the pyriform sinus and aryepiglottic fold; 4 of these patients also had a hypopharyngeal hematoma involving the pyriform sinus, aryepiglottic fold, arytenoid, and false vocal cord, which partially obstructed the airway. These 4 patients were closely monitored for 1 to 2 additional days, and all were discharged without problems. None of the patients in the study had postoperative airway obstruction. Conclusion: NPG may be useful in postoperative airway monitoring and assist in discharge planning after upper airway reconstruction in the OSA patients. © 2000 American Association of Oral and Maxillofacial Surgeons

Studies of the histomorphology and function of the uvula

Alternations in pharyngeal structure and function are considered fundamental in the pathogenesis of snoring or obstructive sleep apnea (OSA). The physiological function of the uvula as a dynamic sealing of the nasopharynx prevents a "craniocaudal aspiration" during deglutition. The oropharyngeal soft tissues and the uvula are known to play an important role in affecting the oropharyngeal airflow resistance but studies about alterations in the histomorphological uvula structure are controversial. We studied the histomorphological tissue composition of the uvula (midsagittal and transversal sections) in 142 patients who underwent uvulopalatopharyngoplasty (UPPP) or uvulopalatoplasty (UPP) for snoring and by autopsy in 30 normal subjects not known to have been snoring. Statistical comparisons were controlled for differences caused by age and body mass index. The uvula was found to be significantly longer in patients with snoring than in control subjects. Patients with snoring had a significantly greater percentage of fat content and connective tissue in combination with a muscle atrophy in the uvula than did normal subjects. The disturbance of the specific muscular composition and formation causes a reduction of muscular tonus and a loss of muscular contraction. The uvula is destabilized on the basis of a missing skeletal and cartilaginous brace. The uvula destabilization causes a narrowing of the pharyngeal airway that could lead to an increased oropharyngeal airflow resistance with an intensified passive uvula movement and vibration during mouth breathing.

Surgical criteria for obstructive sleep apnea syndrome based on localization of upper airway collapse during sleep: a preliminary study.

Obstructive sleep apnea syndrome (OSAS) is defined as intermittent complete or partial upper airway obstruction during sleep, causing mental and physical effects. Localization of obstructions in the upper airways in OSAS patients provides indispensable information for the selection of surgical procedures. We measured the pressure within the upper airways during sleep in 6 patients with OSAS in order to select the surgical procedure. Five patients were found to have the airway collapse in the velopharynx, and in three of them underwent uvulopalatopharyngoplasty (UPPP) with tonsillectomy was performed. The remaining one patient, having an obstruction in both the velopharynx and hypopharynx, underwent laser-assisted midline glossectomy as well as UPPP. The 4 patients receiving the operation showed improvements in the sleep apnea index and the lowest oxygen saturation postoperatively. These findings suggest that pressure measurement may be a reliable tool for localizing obstructions in OSAS patients and may be used for determined the surgical option.

閉塞型睡眠時無呼吸症における閉塞部位診断 薬物睡眠下内視鏡検査を用いて

Objective: 55 patients diagnosed as having obstructive sleep apnea syndrome (OSAS) underwent uvulopalatopharyngoplasty (UPPP). The effects of surgery were studied based on the findings of endoscopic examination under drug-induced sleep and AHI measurements performed before and after the operation. Changes in airway form during sleep were observed, and the usefulness of upper airway endoscopy in the diagnosis and surgical treatment of OSAS was studied.Methods: The site of airway obstruction during sleep induced by intravenous injection of 10mg of diazepam was classified into five types, and changes in AHI and the site of airway obstruction were compared before and after surgery.Results: The postoperative improvement rate was 73.5% in the soft palate type of obstruction, 75.6% in the tonsillar type, 52.3% in the full-circumference palatal type and 32.3% in the mixed type. Surgical treatment by UPPP had an excellent or good effect on the soft palate and tonsillar types. However, many patients with the ful1-circumference palatal type and the mixed type showed less improvement compared with the soft palate and tonsillar type.Conclusion: In the full-circumference palatal type and the mixed type, improvement can be expected following operations which include surgical treatment of the posterior pharyngeal wall or the lateral funiculus, or midline laser glossectomy.

Difficult laryngoscopy and cephalometric roentgenograms in obstructive sleep apnea syndrome patients undergoing uvulopalatopharyngoplasty.

We retrospectively studied the incidence of difficult laryngoscopy in 53 subjects with obstructive sleep apnea syndrome (OSAS) undergoing uvulopalatopharyngoplasty (UPPP) and 72 subjects with chronic otitis media undergoing tympanoplasty (control group). The incidence of difficult laryngoscopy in the UPPP group was significantly higher than in the control group (18.9%vs 4.2%,P<0.001). To analyze the anatomical findings of difficult laryngoscopy in UPPP patients, cephalometric roentgenograms were compared between patients in whom direct laryngoscopy was difficult (difficult patients,n=10) and patients in whom direct laryngoscopy was not difficult (nondifficult patients,n=43). Cephalometric atlanto-occipital distance (cAOD) was less than 4mm in 80% of the difficult patients, and there were significant differences between the difficult patients and the nondifficult patients (2.8±3.3 mmvs 6.7±3.0 mm, mean ±SD,P<0.001). There were significant differences in cephalometric effective mandibular length/cephalometric posterior depth of mandible ratio (cEML/cPDM) between the difficult patients and the nondifficult patients (4.0±0.6vs 4.5 ±0.8,P<0.01); however, the calculation of cEML/cPDM was more difficult than cAOD. We concluded that OSAS patients undergoing UPPP are at high risk for difficult laryngoscopy, and that cAOD calculated from cephalometric roentgenograms is an easy and sensitive predictive indicator for the estimation of difficult laryngoscopy.

Objective measurement of the results of uvulopalatopharyngoplasty.

Thirty-two patients undergoing uvulopalatopharyngoplasty (UPPP) for snoring have been studied prospectively using objective measurement of snoring levels. A significant reduction was found, especially in the supine posture. The quantitative reduction was small and correlations between subjective and objective changes in snoring volume were weak.