A Prospective Study of the Surgical Outcome of Simple Uvulopalatopharyngoplasty (UPPP), UPPP Combined With Genioglossus Advancement or Tongue Base Advancement for Obstructive Sleep Apnea Hypopnea Syndrome Patients With Multilevel Obstruction

ObjectivesTo investigate the surgical outcomes of different uvulopalatopharyngoplasty (UPPP).Methods All subjects underwent overnight polysomnography and were evaluated using the Epworth sleepiness scale (ESS), the Quebec sleep questionnaire and the snoring scale at the baseline and 3 and 12 months following operation. The primary endpoint was the overall effective rate representing the sum of the surgical success rate and effective rate.ResultsThe overall effective rate at 12 months post surgery was 55.6% for simple UPPP, 95.8% for UPPP+GA, and 92.3% for UPPP+TBA. The surgical success rate at 3 and 12 months postoperation for UPPP+GA or UPPP+TBA was significantly higher than simple UPPP (P<0.05). Marked improvement was observed in all patients in the snoring scale score and the ESS score 3 and 12 months following surgery compared to the baseline (P<0.05 in all).ConclusionUPPP, UPPP+GA, and UPPP+TBA are all effective in improving the surgical outcome of obstructive sleep apnea hypopnea syndrome (OSAHS) patients with multilevel obstruction. UPPP+TBA appears to be the most effective in treating OSAHS patients.     

Relationship Between Snoring Intensity and Severity of Obstructive Sleep Apnea

Objectives

The aim of this study was to determine the relationship between the intensity of snoring and severity of sleep apnea using Watch-PAT (peripheral arterial tone) 100.

Methods

A total of 404 patients (338 males and 66 females) who underwent home-based portable sleep study using Watch-PAT 100 for obstructive sleep apnea (OSA) from January 2009 through December 2011 were included in this study. Subjects were divided into 4 groups; no OSA (PAT apnea hypopnea index [pAHI]<5/hour), mild OSA (5≤pAHI<15/hour), moderate OSA (15≤pAHI<30/hour), or severe OSA groups (pAHI≥30/hour). Mean snoring intensity and percent sleep time with snoring intensity greater than 40, 50, and 60 dB were measured by Watch-PAT 100. Correlations of these parameters with apnea hypopnea index (AHI), respiratory disturbance index (RDI), and oxygen desaturation index were assessed.

Results

The mean age and body mass index were 46.5±14.8 years and 24.7±3.4 kg/m², respectively. Mean AHI and RDI were 16.5±15.3/hour and 20.8±14.3/hour, respectively. The mean snoring intensity in the no, mild, moderate, and severe OSA groups was 44.0±2.7, 45.4±6.0, 47.7±5.0, and 50.5±5.6 dB, respectively (P<0.001). There was a positive correlation between snoring intensity and pAHI or PAT RDI (pRDI) (r=0.391 and r=0.385, respectively, both P<0.001). There was also a positive correlation between percent sleep time with the snoring intensity greater than 50 dB and pAHI or pRDI (r=0.423 and r=0.411, respectively, both P<0.001).

Conclusion

This study revealed that the intensity of snoring increased with the severity of sleep apnea, which suggests that the loudness of snoring might be an indicator of the severity of OSA.     

Allergic Rhinitis does not Constitute a Risk Factor for Obstructive Sleep Apnea Syndrome

Obstructive sleep apnea syndrome (OSAS) is a condition characterized by recurrent episodes of obstruction of the upper airway. The aim of this study was to evaluate whether nasal obstruction due to allergic rhinitis constitutes a risk factor for OSAS. Patients (n = 119) presenting typical symptoms of sleep apnea were tested for OSAS using polysomnography. Additionally all patients were tested in vivo and in vitro (including nasal eosinophilic cationic protein) for allergic rhinitis. Examination for allergic rhinitis revealed that 88.3% of all patients had no allergic rhinitis, whereas only 11.7% were diagnosed as allergic. No significant differences in sleeping parameters were observed between allergic and non-allergic patients. Comparison of parameters indicative of relevant OSAS (apnea-hypopnea index [AHI] &gt; 10) revealed that 60% of non-allergic patients had relevant OSAS, compared to only 50% of allergic patients. Investigation of allergic subgroups revealed similar results: no significant differences in sleeping parameters or elevated rates of relevant OSAS parameters were observed, especially in perennial allergic rhinitis due to house dust mites. No elevated rates of allergic rhinitis were observed in the studied cohort of patients suffering from sleep apnea or OSAS. Furthermore, no significant differences in sleeping behavior or polysomnography parameters were found on comparing allergic and non-allergic patients. In summary, our data rule out allergic rhinitis as a major risk factor for OSAS.     

Cephalometric and Fiberoptic Evaluation as a Case-selection Technique for Obstructive Sleep Apnea Syndrome (OSAS)

In order to obtain relatively simple and useful parameters to estimate the severity of obstructive sleep apnea syndrome (OSAS), cephalometric and fiberoptic studies were performed in 64 clinical cases previously diagnosed with either OSAS or snoring. Fourteen cephalometric parameters, 13 parameters derived from physical examination and 18 fiberoptic parameters were compared with the apnea index (AI), the apnea -hypopnea index and lowest SaO 2 values. Statistically significant correlations were found between the AI and the shortest linear distance from the posterior line of the soft palate to the posterior pharyngeal wall measured along a line parallel to the supramentale-Gonion line (PAS-epipharynx distance), the distance from the mandibular plane to the most anterior and superior point on the body of the hyoid bone obtained from cephalometry (MP-H distance) and the degree of redundancy of mucosa in the arytenoid/aryepiglottic fold obtained from videoendoscopy. An increased AI was observed when the PAS-epipharynx distance was <7 mm and there was 100% obstruction in Muller's maneuver at the palate level (supine), the MP-H distance was >27.4 mm and the mucosa of the arytenoid/aryepiglottic fold was markedly redundant. As these three parameters are relatively easy to obtain on an outpatient basis, it is suggested that they could be used in an outpatient setting to provide a good prediction of the severity of OSAS.     

The Emerging Role of Drug-Induced Sleep Endoscopy in the Management of Obstructive Sleep Apnea

Obstructive sleep apnea is a prevalent sleep disorder characterized by partial or complete obstruction of the upper airway. Continuous positive airway pressure is the first-line therapy for most patients, but adherence is often poor. Alternative treatment options such as mandibular advancement devices, positional therapy, and surgical interventions including upper airway stimulation target different levels and patterns of obstruction with varying degrees of success. Drug-induced sleep endoscopy enables the visualization of upper airway obstruction under conditions mimicking sleep. In the era of precision medicine, this additional information may facilitate better decision-making when prescribing alternative treatment modalities, with the hope of achieving better adherence and/or success rates. This review discusses the current knowledge and evidence on the role of drug-induced sleep endoscopy in the non-positive airway pressure management of obstructive sleep apnea.     

Five-Year Subjective Outcomes of Obstructive Sleep Apnea Surgery: A Multiinstitutional Study

Objectives

To evaluate the effect of obstructive sleep apnea (OSA) surgery on long-term (5-year) subjective outcomes, including sleep disordered breathing (SDB) symptoms and other complications, in patients with OSA.

Methods

We enrolled patients who underwent diagnostic polysomnography for OSA between January 2006 and December 2006 in ten hospitals. Patients either were treated for OSA or were not treated for OSA. All patients completed a brief telephone survey regarding their SDB signs and symptoms (e.g., snoring, apnea, nocturnal arousals, and daytime sleepiness), positive airway pressure (PAP) compliance, and any adverse effects of either the surgery or PAP. A positive subjective outcome for either surgery or no treatment was taken to be the alleviation of apnea, defined as a ≥50% increase in score. A positive subjective outcome (compliance) for PAP was defined as a PAP usage of ≥4 hours per night and ≥5 days per week.

Results

A total of 229 patients were included in this study. Patients were divided into three groups: a surgery group (n=87), a PAP group (n=68), and a control (untreated) group (n=74). The surgery group exhibited significant improvement in all SDB symptoms compared with the control group. The long-term subjective outcomes of the surgery (52.9%) and PAP (54.4%) groups were significantly better than those of the control group (25.0%). The subjective outcome of the surgery group was not significantly different from that of the PAP group. The overall surgical complication rate was 23.0% (20 of 87) in the surgery group, and 55.0% (22 of 40) of all patients with PAP experienced adverse effects.

Conclusion

The extent of SDB symptoms was consistently improved in patients with OSA at 5 years postsurgery. Information about the potential long-term subjective outcomes should be provided to patients when considering surgery.     

Preliminary Findings from Our Experience in Anterior Palatoplasty for the Treatment of Obstructive Sleep Apnea

Objectives

Obstructive sleep apnea (OSA) is a common disorder affecting at least 2% to 4% of adult population characterized by the collapse of the pharyngeal airway. It is well established that retropalatal region is the most common site of obstruction. Consequently, many surgical techniques have been introduced. The purpose of this study is to present our preliminary results in the anterior palatoplasty (AP) compared with results of uvulopalatal flap (UPF).

Methods

Thirty-eight consecutive patients with mild-moderate OSA were prospectively enrolled into a randomised surgical protocol. Surgical success was measured primarily by satisfactory reduction in snoring, as reported by snoring assessment questionnaire (SQ) of sleep partners. Secondary outcomes measures included improvement in the Epworth Sleepiness Scale (ESS) scores, changes in the magnitude of pharyngeal collapse, and postoperative pain intensity.

Results

The ESS after AP improved from a preoperative value 8.5±3.7 to a postoperative mean of 4.9±3.2 (P<0.001) after UPF improved from a preoperative value of 8.1±3.5 to 5.2±3.2 postoperatively (P<0.001). The results of satisfactory reduction in the volume of snoring and response at polysomnographic data were also similar in both procedures. We reported a statistically significant difference of the collapse noted at Müller manoeuvre that improved from 2.7±1.0 on average, to 1.1±0.9 (P<0.001) after AP and with a lesser extent, (from 2.8±1.1 on average to 1.8±1.1; P<0.05), after UPF. The mean duration of pain was 10.8 days for UPF patients and 7.1 days for AP patients. The mean pain score in the first 3 days, was 6.8 in UPF patients and 5.1 in AP patients.

Conclusion

The subjective and objective improvements evidenced may suggest how AP is far superior to other techniques aimed at creating a palatal fibrotic scar. In the light of these results we can suggest AP procedure as more practical and comfortable when compared to UPF.     

等离子射频舌根部分切除术治疗阻塞性睡眠呼吸暂停低通气综合征

目的探讨提高阻塞性睡眠呼吸暂停低通气综合征(obstructivesleepapneahypopneasyndrome,OSAHS)的有效治疗方法。方法采用等离子低温射频舌根部分切除术治疗72例OSAHS,术前及术后12周进行多导睡眠仪监测和Epworth嗜睡程度评分确定治疗效果。结果术后舌根体积明显缩小,自觉症状明显改善,Epworth嗜睡程度评分较治疗前明显降低和AHI明显降低。结论等离子低温射频舌根部分切除术在阻塞性睡眠呼吸暂停综合征的治疗中显示出一定的可行性、有效性和安全性。为临床医师提供了一种新的、理想的治疗手段。在上气道阻塞性疾病的治疗中将有更加广阔的应用前景。     

Long-term Subjective and Objective Outcomes of Adenotonsillectomy in Korean Children With Obstructive Sleep Apnea Syndrome

Objectives

Adenotonsillar hypertrophy is the most common etiology in pediatric obstructive sleep apnea syndrome (OSAS), and adenotonsillectomy is the mainstay of treatment modalities. This study evaluates the long-term effectiveness of adenotonsillectomy in children with OSAS.

Methods

Subjective symptoms evaluated with a 7-point Likert scale and objective respiratory disturbances evaluated by polysomnography were compared before and after adenotonsillectomy.

Results

A total of 17 children with OSAS aged 4-15 years (mean age, 6.65±3.02 years; male:female, 13:4) completed the study. The mean follow-up period was 57 months (range, 30 to 98 months). Significant changes were found in apnea-hypopnea index (from 12.49±12.96 to 1.96±2.01, P<0.001), apnea index (from 5.64±7.57 to 0.53±0.78, P=0.006), minimum SaO₂ (from 81.88±14.36 to 92.76±4.31, P=0.003), snoring (from 43.28±70.63 to 10.70±13.72, P=0.042), and arousal index (from 19.58±7.57 to 11.36±3.99, P=0.006) after adenotonsillectomy. Significant changes were also found after surgery in most of symptoms including snoring, witnessed apnea, morning headache, mouth breathing, gasping during sleep, restless sleep, nasal obstruction, and difficulty with morning arousal. Long-term surgical cure rate and response rate were 47.1% (8/17) and 70.6% (12/17), respectively.

Conclusion

Most of subjective OSAS symptoms and objective respiratory disturbances improved continuously about 5 years after adenotonsillectomy in children with OSAS. However, close follow-up and a sufficient observation period are necessary because of the risk for long-term incomplete resolution.     

Therapeutic Effect of Multilevel Surgery on Laryngopharyngeal Reflux in Obstructive Sleep Apnea Patients: Impact on the Reflux Symptom Index and Reflux Finding Score

Objectives.Our previous study found that multilevel obstructive sleep apnea (OSA) surgery mitigated laryngopharyngeal reflux (LPR) symptoms in terms of the reflux symptom index (RSI), but no studies have investigated the impact of OSA surgery on laryngoscopic parameters. The aim of this study was to examine the clinical outcome of LPR improvement following OSA surgery, with a focus on both the RSI and the reflux finding score (RFS).Methods.Prospectively collected data from 28 patients who underwent multilevel OSA surgery from 2017 to 2021 were retrospectively analyzed. Patients were asked to complete the RSI questionnaire and underwent a laryngoscopic examination to evaluate the RFS before and after surgery. Age, height, weight, body mass index (BMI), and polysomnography data before and after surgery were also reviewed.Results.After surgery, the total RSI and RFS decreased significantly from 11.96±8.40 to 7.68±6.82 (P=0.003) and from 6.57±3.49 to 3.21±1.87 (P<0.001). The positive rates of RSI and RFS decreased from 28.6% to 17.9% and 32.1% to 0%, respectively. Significant improvements were found in the RSI subdomains of throat clearing, throat mucus, breathing difficulty, troublesome cough, and heartburn sensation, while all RFS subdomains except granuloma improved significantly. In subgroup analyses, no significant differences were found between subgroups based on age, OSA severity, or BMI.Conclusion.OSA surgery has the potential to alleviate both LPR symptoms and laryngoscopic results. Additional research integrating more objective techniques and novel treatment strategies is required to better comprehend the clinical impact of OSA surgery on LPR.     

Long‐Term Results of Uvulopalatopharyngoplasty for Obstructive Sleep Apnea Syndrome

Objectives Assessment of the long‐term effect of uvulopalatopharyngoplasty (UPPP) on snoring, excessive daytime sleepiness, and nocturnal oxygen desaturation index (ODI) in patients with obstructive sleep apnea syndrome. Study Design Evaluation of snoring, excessive daytime sleepiness, and ODI in patients treated by UPPP earlier. Materials and Methods Patients (n = 58) with a follow‐up period of 11 to 74 months (median, 34 mo) were included in this study. Snoring and excessive daytime sleepiness were scored on specially designed semiquantitative scales. In all patients ODI was calculated from pulse‐oximetry combined with polysomnography at base line and by polygraphy (MESAM 4) during follow‐up in 38 patients. Long‐term response was compared with 6‐month response in the same cohort. Results There was a long‐term improvement of snoring in 63% of patients, no change in 23%, and a deterioration in 14% (P < .00001). Overall snoring increased slightly between 6 months and long‐term follow‐up. There was an improvement of excessive daytime sleepiness in 38%, no change in 27%, and a deterioration in 35% (P = .80). Excessive daytime sleepiness showed a relapse to preoperative levels between 6 months and long‐term follow‐up. The median improvement of ODI was ?1 (95% interpercentile range, 73–51) and was not significant (P = .35). In 5 of 13 patients in whom ODI at baseline exceeded 20, ODI was reduced to less than 20. In 4 of the 38 patients ODI was reduced to less than 5. The improvement of ODI decreased significantly between 6 months and long‐term follow‐up (P = .03). No relation was found between body mass index, Mueller maneuver, X‐cephalometry, and long‐term outcome. An additional finding was that the ODI decreased after UPPP in combination with tonsillectomy, compared with a slight increase after UPPP alone; the difference was significant (P = .008). Conclusion The response to UPPP for obstructive sleep apnea syndrome decreases progressively over the years after surgery. UPPP in combination with tonsillectomy was more effective than UPPP alone.     

中、重度OSAHS患者上气道不同阻塞部位鼾声声压级指标分析

目的：研究中、重度阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hyperpnoea syn-drome,OSAHS）患者上气道不同阻塞部位与鼾声声压级指标的关系。方法对46例经多导睡眠监测诊断为中度或重度OSAHS的患者进行整夜同步上气道测压和鼾声声压级记录,分析上气道阻塞部位构成比、每小时上部（软腭游离缘平面以上）和下部（软腭游离缘平面以下）阻塞次数与鼾声声压级分析指标中等效连续A声级（equivalent continuous A－weightedsound level,LAeq ）和最大声压级（L10）的相关性,以及上气道阻塞部位的类型、呼吸暂停低通气指数（AHI）及体质量指数（BMI）对鼾声声压级指标的影响。结果 OSAHS 患者上气道上／下部阻塞构成比和每小时上部及下部阻塞次数均与LAeq和L10无明显相关性,LAeq和L10的影响因素为AHI,而阻塞部位及BMI 对LAeq和L10无影响。结论 LAeq和L10的大小与AHI有关而与阻塞部位无明确关系,LAeq和L10可能有助于初步判断OSAHS患者的严重程度,对阻塞部位的辨别缺乏临床价值。     

OSA H S患者与单纯打鼾者鼾声声学特性初步研究

目的利用鼾声监测及分析技术对OSAHS患者和单纯打鼾者的鼾声的声学特性进行初步研究。方法阻塞性睡眠呼吸暂停低通气综合征（OSAHs）患者22人,单纯打鼾（simple snoring）者15人,分别同步进行鼾声监测和睡眠呼吸监测。取每例单纯打鼾者10次鼾声和每例OSAHS患者10次阻塞性呼吸暂停后的第一次鼾声进行时域和频域特性分析。结果单纯打鼾者鼾声片断时域曲线表现为多个振幅、间隔大致相仿的复合波,频域曲线表现出明显的基一频谐波结构;OSAHS患者鼾声的时域曲线表现为多个振幅、间隔不规则的复合波,频域曲线中无明显的基频一谐波结构。OSAHS患者鼾声的峰频率、中心频率较单纯打鼾者高,800Hz功率比率较单纯打鼾者低,OSAHS组,中重度OSAHS患者的鼾声峰频率、中心频率较轻度者高,800Hz功率比率较轻度者低,中心频率和800Hz功率比率的差异有统计学意义（P〈0．05）。结论0SAHS患者和单纯打鼾者鼾声具有不同的时域特性和频域特性,表明两种鼾声在声学上有质的差别,提示将鼾声监测分析技术应用于OSAHS的研究具有一定可行性,并可能为确定阻塞部位及鼾声来源提供新的临床研究思路。     

鼻内镜下腺样体低温等离子消融术和动力切割术的疗效比较

目的：分别通过低温等离子射频消融和鼻动力切割进行腺样体切除,观察两种手术方式的手术时间、出血量及疗效,分析两种手术方式的优缺点。方法收集2008年1月～2011年12月我院收治的儿童阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome,OSAHS）中,扁桃体和/或腺样体肥大的患儿共75例,其中30例行鼻动力切割腺样体切除术,45例行低温等离子射频消融腺样体切除术,统计两种术式的手术时间、出血量及术后半年疗效（儿童OSAHS疾病特异性生活质量调查（OSA-18））评估有无差异。结果鼻动力切割组与等离子消融组比较,两者切除腺样体手术时间差异无统计学意义,但是鼻动力切割组出血量明显多于等离子消融组,差异有统计学意义（P〈0.05）,两者手术方式对儿童阻塞性睡眠呼吸暂停低通气综合征都有治疗效果。结论两种术式术后都能改善患儿的生活质量,疗效满意;鼻内镜下等离子低温射频消融腺样体切除术较鼻动力切割手术出血明显减少,值得推广。     

电影磁共振及纤维喉镜对阻塞性睡眠呼吸暂停低通气综合征患者上气道阻塞部位检查对比研究

目的 探讨电影磁共振(cine magnetic resonance,CMR)检查及纤维喉镜下Müller试验对阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome , OSAHS)患者进行上气道阻塞部位定位的应用价值.方法 选取2015年9月~2016年4月到郑州大学第一附属医院咽喉头颈外科就诊并经多导睡眠监测(PSG)及专科检查确诊的阻塞性睡眠呼吸暂停低通气综合征患者22例,于术前行纤维喉镜下Müller试验检查并分别在睡眠及清醒状态下行电影磁共振检查,观察软腭区、舌后区及会厌区狭窄或阻塞发生情况.结果 电影磁共振与纤维喉镜下Müller试验对于软腭区阻塞的定位(22例对22例)具有完全的一致性(Kappa=1),而对于舌后区(13例对6例)(Kappa=0.412)、会厌区(4例对2例)(Kappa=0.621)及多部位同时阻塞的定位(13例对6例)(Kappa=0.412),二者一致性一般.结论 对多部位阻塞的中重度OSAHS患者,术前应用电影磁共振及纤维喉镜检查能够更好地明确阻塞部位.