An International Journal of Otorhinolaryngology Clinics

Register      Login

VOLUME 6 , ISSUE 3 ( Number, 2014 ) > List of Articles

RESEARCH ARTICLE

Multilevel Surgery in Moderate to Severe Obstructive Sleep Apnea Patients

Jumroon Tungkeeratichai, Navarat Apirakkittikul, Somyos Kunachak

Keywords : Apnea hypopnea index,Glossectomy,Lateral pharyngoplasty,Multilevel surgery in obstructive sleep apnea,Obstructive sleep apnea,Uvulopalatoplasty

Citation Information : Tungkeeratichai J, Apirakkittikul N, Kunachak S. Multilevel Surgery in Moderate to Severe Obstructive Sleep Apnea Patients. Int J Otorhinolaryngol Clin 2014; 6 (3):87-91.

DOI: 10.5005/jp-journals-10003-1162

Published Online: 01-12-2014

Copyright Statement:  Copyright © 2014; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Objective

The aim of this study was to investigate the objective and subjective effectiveness of multilevel surgery, i.e. combined lingualplasty with new technique of partial posterior glossectomy (PPG) and uvulopalatopharyngoplasty in moderate to severe obstructive sleep apnea (OSA) patients.

Study design and setting

Retrospective study of 60 OSA patients undergoing multilevel surgery for the treatment of moderate to severe OSA.

Results

Preoperative mean apnea hypopnea index (AHI) was 57.5 events/h and preoperative mean lowest SpO2 was 79.1%. After multilevel surgery, postoperative mean AHI significantly decreased to 29.7 events/h (p < 0.001) and postoperative mean lowest SpO2 increased to 84.4% (p < 0.001). Patients had postoperative followup assessments for 1 to 3 years. Results of surgery was classified as curative in 35/60 (58.3%) of patients, and as effective, i.e. postoperative AHI less than preoperative AHI in 52/60 patients (86.7 %). Surgery was ineffective in 8/60 (13.3%) patients. Early postoperative complications comprised early velopharyngeal insufficiency (VPI) 20% (12/60), dysarthria 20% (12/60) and wound dehiscence 3.33% (2/60) but without serious complications after 1 year.

Conclusion

Combined lingualplasty (with new PPG) and uvulopalatopharyngoplasty (UPPP) as multilevel surgery can be an effective treatment of choice for patients with moderate to severe OSA. No mediumterm serious complication was found.

Keywords

Apnea hypopnea index, Glossectomy, Lateral pharyngoplasty, Multilevel surgery in obstructive sleep apnea, Obstructive sleep apnea, Uvulopalatoplasty.

How to cite this article

Tungkeeratichai J, Apirakkittikul N, Kunachak S. Multilevel Surgery in Moderate to Severe Obstructive Sleep Apnea Patients. Int J Otorhinolaryngol Clin 2014;6(3):8791.


PDF Share
  1. The occurrence of sleep disordered breathing in middle-aged adults. N Engl J Med 1993;328(17):1230–1235.
  2. Anatomy of the pharynx in patients with obstructive sleep apnea and in normal subjects. J Appl Physiol 1997;82(4):1319–1326.
  3. Upper airway collapsibility in snorers and in patients with obstructive sleep apnea. Am Rev Resp Dis 1991;143(6):1300–1303.
  4. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study: Sleep Heart Health Study. JAMA 2000;283(14):1829–1836.
  5. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 2000;342(19):1378–1384.
  6. Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest 1995;96(4):1897–1904.
  7. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 2001;163(1):19–25.
  8. Objective measurement of pattern of nasal CPAP use by patients with obstructive sleep apnea. Am Rev Respir Dis 1993;147(4):887–895.
  9. Predictive factors of long term compliance with nasal continuous positive airway pressure treatment in sleep apnea syndrome. Chest 1994;105(2):429–433.
  10. Can the Müller maneuver detect multilevel obstruction of the upper airway in patients with obstructive sleep apnea syndrome? Kulak Burun Bogaz Ihtis Derg 2010;20(2):84–88.
  11. Surgical correction of anatomic abnormality in obstructive sleep apnea syndrome: uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg 1981;89(6):923–934.
  12. Uvulopalatopharyngoplasty in the management of obstructive sleep apnea: the Mayo Clinic experience. Mayo Clinic Proc 2009;84(9):795–800.
  13. Simple predictors of uvulopalatopharyngoplasty outcome in the treatment of obstructive sleep apnea. Chest 2000;118(4):1025–1030.
  14. Otolaryngol Clin North Am 2007;40:11–12.
  15. Multilevel pharyngeal surgery for obstructive sleep apnea syndrome: indication and techniques. Op Tech Otolaryngol Head Neck Surg 2000;11(1):12–20.
  16. The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep 1996;19(2):156–177.
  17. Inferior sagittal osteotomy of mandible with hyoid myotomy-suspension: a new procedure for obstructive sleep apnea. Otolaryngol Head Neck Surg 1986;94(5):589–593.
  18. Obstructive sleep apnea syndrome: a review of 306 consecutively treated surgical patients. Otolaryngol Head Neck Surg 1993;108(2):117–125.
  19. Obstructive sleep apnea: long-term clinical outcomes. Otolaryngol Head Neck Surg 2000;122(3):415–421.
  20. Maxillomandibular advancement for obstructive sleep apnea. Oral Maxillofac Surg 2011;69(3):1659–1677.
  21. Staged surgical treatment of obstructive sleep apnea syndrome: a review of 35 patients. J Oral Maxillofac Surg 1999;57(4):382–385.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.