Predictors of Surgical Outcomes of Uvulopalatopharyngoplasty for Obstructive Sleep Apnea Hypopnea Syndrome

2011 ◽  
Vol 145 (6) ◽  
pp. 1049-1054 ◽  
Author(s):  
Yuan Ping Xiong ◽  
Hong Liang Yi ◽  
Shan Kai Yin ◽  
Li Li Meng ◽  
Xu Lan Tang ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Lipid Metabolism ◽  
Sleep Apnea ◽  
Oxygen Saturation ◽  
Success Rate ◽  
Surgical Outcomes ◽  
Apnea Hypopnea Index ◽  
Glucose And Lipid Metabolism ◽  
Obstructive Sleep ◽  
Hypopnea Syndrome

Objectives. To investigate predictors of surgical outcomes of uvulopalatopharyngoplasty (UPPP) for obstructive sleep apnea hypopnea syndrome (OSAHS). Study Design. Case series with planned data collection. Setting. A university medical center. Subjects and Methods. Thirty-nine patients with OSAHS received Z-palatopharyngoplasty (ZPPP) or Han-uvulopalatopharyngoplasty (H-UPPP). All patients were evaluated within 3 months before surgery and at 6 to 12 months after surgery. Statistical analyses were conducted on preoperative parameters that could have affected surgical efficacy and outcome. Success was defined as an apnea–hypopnea index (AHI) fewer than 20 times per hour and a decrease of more than 50%. Results. The success rate was 56.4% (22/39 patients). There were statistically significant differences in AHI, lowest oxygen saturation (L-Sao2), time with oxygen saturation less than 90% (CT90), percentage of time with oxygen saturation less than 90% (CT90%), microarousal index (MI), apolipoprotein E (ApoE), high-density lipoprotein (HDL), fasting blood glucose (FBG), and Friedman OSA stage between the treatment success and failure groups. Higher success rate was predicted by lower severity, as indicated by lower AHI, CT90, CT90%, and MI; higher L-Sao2; and fewer glucose and lipid metabolism abnormalities, shown by lower ApoE and FBG and higher HDL. Conclusions. Disease severity, glucose and lipid metabolism, and Friedman OSA stage may be important predictors of surgical outcome of UPPP for OSAHS.

Adenotonsillectomy for the Treatment of Obstructive Sleep Apnea in Children with Prader-Willi Syndrome: A Meta-analysis

2019 ◽  
Vol 162 (2) ◽  
pp. 168-176
Author(s):  
Chia-Hsuan Lee ◽  
Wei-Chung Hsu ◽  
Jenq-Yuh Ko ◽  
Te-Huei Yeh ◽  
Ming-Tzer Lin ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Success Rate ◽  
Cochrane Review ◽  
Velopharyngeal Insufficiency ◽  
Apnea Hypopnea Index ◽  
Prader Willi Syndrome ◽  
Postoperative Changes ◽  
Obstructive Sleep ◽  
Osa Treatment

Objective Adenotonsillectomy outcomes in obstructive sleep apnea (OSA) treatment among children with Prader-Willi syndrome (PWS) remain unclear. This study aimed to elucidate the effectiveness of adenotonsillectomy in OSA treatment among children with PWS. Data Source PubMed, MEDLINE, Embase, and Cochrane Review up to February 2019. Review Methods The registry number of the protocol published on PROSPERO was CRD42015027053. Two authors independently searched the relevant database. Polysomnography outcomes in these children were examined, including net postoperative changes in the apnea-hypopnea index (AHI), net postoperative changes in the minimum and mean oxygen saturation, the overall success rate for a postoperative AHI <1, and the overall success rate for a postoperative AHI <5. Results Six studies with 41 patients were analyzed (mean age, 5.0 years; 55% boys; mean sample size, 6.8 patients). All children had PWS and received adenotonsillectomy for the treatment of OSA. The AHI was 13.1 events per hour (95% CI, 11.0-15.1) before surgery and 4.6 events per hour (95% CI, 4.1-5.1) after surgery. The mean change in the AHI was a significant reduction of 8.0 events per hour (95% CI, −10.8 to −5.1). The overall success rate was 21% (95% CI, 11%-38%) for a postoperative AHI <1 and 71% (95% CI, 54%-83%) for a postoperative AHI <5. Some patients developed velopharyngeal insufficiency postoperatively. Conclusion Adenotonsillectomy was associated with OSA improvement among children with PWS. However, residual OSA was frequently observed postoperatively in these patients.

Long-term Results for Maxillomandibular Advancement to Treat Obstructive Sleep Apnea: A Meta-analysis

2019 ◽  
Vol 160 (4) ◽  
pp. 580-593 ◽  
Author(s):  
Macario Camacho ◽  
Michael W. Noller ◽  
Michael Del Do ◽  
Justin M. Wei ◽  
Christopher J. Gouveia ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Oxygen Saturation ◽  
Long Term Results ◽  
Cochrane Library ◽  
Apnea Hypopnea Index ◽  
International Literature ◽  
Maxillomandibular Advancement ◽  
Obstructive Sleep

Objective To examine outcomes in the intermediate term (1 to <4 years), long term (4 to <8 years), and very long term (≥8 years) for maxillomandibular advancement (MMA) as treatment for obstructive sleep apnea (OSA). Data Sources The Cochrane Library, Google Scholar, Embase, Cumulative Index to Nursing and Allied Health, and PubMed/MEDLINE. Review Methods Three authors systematically reviewed the international literature through July 26, 2018. Results A total of 445 studies were screened, and 6 met criteria (120 patients). Thirty-one patients showed a reduction in apnea-hypopnea index (AHI) from a mean 48.3 events/h (95% CI, 42.1-54.5) pre-MMA to 8.4 (95% CI 5.6, 11.2) in the intermediate term. Fifty-four patients showed a reduction in AHI from a mean 65.8 events/h (95% CI, 58.8-72.8) pre-MMA to 7.7 (95% CI 5.9, 9.5) in the long term. Thirty-five showed a reduction in AHI from a mean 53.2 events/h (95% CI 45, 61.4) pre-MMA to 23.1 (95% CI 16.3, 29.9) in the very long term. Improvement in sleepiness was maintained at all follow-up periods. Lowest oxygen saturation improvement was maintained in the long term. Conclusion The current international literature shows that patients with OSA who were treated with MMA maintained improvements in AHI, sleepiness, and lowest oxygen saturation in the long term; however, the mean AHI increased to moderate OSA in the very long term. Definitive generalizations cannot be made, and additional research providing individual patient data for the intermediate term, long term, and very long term is needed.

scholarly journals Uvulopalatopharyngoplasty and barbed reposition pharyngoplasty with and without hyoid suspension for obstructive sleep apnea hypopnea syndrome: A comparison of long-term functional results

2020 ◽  
Author(s):  
Antonio Minni ◽  
Fabrizio Cialente ◽  
Massimo Ralli ◽  
Andrea Colizza ◽  
Quirino Lai ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Protective Factor ◽  
Surgical Techniques ◽  
Functional Results ◽  
Apnea Hypopnea Index ◽  
Obstructive Sleep ◽  
Hyoid Suspension ◽  
Hypopnea Syndrome

Obstructive sleep apnea hypopnea syndrome (OSAHS) is a common condition; when conservative approaches are not effective, surgical techniques aimed at reducing the airway obstruction effect are used. This retrospective study aimed at comparing the functional outcomes in patients with OSAHS undergoing uvulopalatopharyngoplasty (UPPP) according to Fairbanks and barbed reposition pharyngoplasty (BRP) according to Mantovani, with or without hyoid suspension (HS). One-hundred twenty-two consecutive OSAHS patients who underwent surgical treatment were included in the study. Patients were divided into 4 groups; all patients underwent preoperative and postoperative polysomnography (PSG) with apnea/hypopnea index (AHI) and oxygen desaturation index (ODI) evaluation, and Epworth Sleepiness Scale (ESS) evaluation. The results were analyzed according to the different surgical procedures, in relation to the preoperative PSG and anthropometric data. A significant reduction was observed at 18-month follow-up for patients in BRP group for BMI (p = 0.004), ESS (p < 0.0001), ODI (p < 0.0001), and AHI (p < 0.0001). Risk factors for poor postoperative AHI reduction were evaluated; preoperative AHI was the strongest independent protective factor, while preoperative ODI was the strongest risk factor. The association of HS with UPPP or BRP showed significant results in terms of higher postoperative AHI reduction only when associated to UPPP (p < 0.0001). This study showed that the BRP technique was more effective compared to UPPP for patients with OSAHS. The association of HS showed greater benefits in UPPP compared to BRP.  Randomized prospective trials with longer follow-up are necessary to confirm our results and formulate a more accurate indication of the optimal therapeutic strategy.

scholarly journals A Pharyngoplasty with a Dorsal Palatal Flap Expansion: The Evaluation of a Modified Surgical Treatment Method for Obstructive Sleep Apnea Syndrome—A Preliminary Report

2021 ◽  
Vol 10 (16) ◽  
pp. 3746
Author(s):  
Ewa Olszewska ◽  
Piotr Fiedorczuk ◽  
Adam Stróżyński ◽  
Agnieszka Polecka ◽  
Ewa Roszkowska ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Oxygen Saturation ◽  
Obstructive Sleep Apnea Syndrome ◽  
Sleep Apnea Syndrome ◽  
Apnea Hypopnea Index ◽  
Upper Airways ◽  
Sleep Study ◽  
Obstructive Sleep ◽  
Apnea Syndrome

Surgical techniques for obstructive sleep apnea syndrome (OSAS) constantly evolve. This study aims to assess the effectiveness and safety of a new surgical approach for an OSAS pharyngoplasty with a dorsal palatal flap expansion (PDPFEx). A total of 21 participants (mean age 49.9; mean BMI 32.5) underwent a type III sleep study, an endoscopy of the upper airways, a filled medical history, a visual analog scale for snoring loudness, an Epworth Sleepiness Scale, and a Short Form Health Survey-36 questionnaire. A follow-up re-evaluation was performed 11 ± 4.9 months post-operatively. The study group (4 with moderate, 17 with severe OSAS) showed an improvement in all measured sleep study characteristics (p < 0.05), apnea-hypopnea index (pre-median 45.7 to 29.3 post-operatively, p = 0.009, r = 0.394), oxygen desaturation index (pre-median 47.7 and 23.3 post-operatively, p = 0.0005, r = 0.812), mean oxygen saturation (median 92% pre-operatively and median 94% post-operatively, p = 0.0002, r = 0.812), lowest oxygen saturation (p = 0.0001, r = 0.540) and time of sleep spent with blood oxygen saturation less than 90% (p = 0.0001, r = 0.485). The most commonly reported complications were throat dryness (11 patients) and minor difficulties in swallowing (5 patients transient, 3 patients constant). We conclude that a PDPFEx is a promising new surgical method; however, further controlled studies are needed to demonstrate its safety and efficacy for OSAS treatment in adults.

scholarly journals Application of IoT-based medical diagnosis and treatment in patients with obstructive sleep apnea/hypopnea syndrome in primary hospitals: A preliminary study

2018 ◽  
Vol 01 (03) ◽  
pp. 207-212
Author(s):  
Yuhua Wu ◽  
Jian Zhou ◽  
Jing Li ◽  
Jie Liu ◽  
Shanqun Li ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Medical Technology ◽  
Diagnosis And Treatment ◽  
Apnea Hypopnea Index ◽  
Medical Monitoring ◽  
Obstructive Sleep ◽  
Before And After ◽  
Preliminary Study ◽  
Hypopnea Syndrome

Objective: To conduct a preliminary study of the hierarchical diagnosis and treatment of patients with obstructive sleep apnea/hypopnea syndrome (OSAHS) using the Internet of Things (IoT) medical technology and to explore the feasibility of the hierarchical diagnosis, treatment, and management of OSAHS patients using IoT medicine in primary hospitals. Methods: The IoT technology and a remote medical monitoring system were used to observe and compare the respiratory and sleep parameters before and after a three-month intervention in 47 patients with OSAHS who met the diagnostic criteria and were selected in the Kashgar region. All parameters were compared based on the severity (mild, moderate, and severe) of OSAHS. Results: The Epworth Sleepiness Scale (ESS) score, apnea–hypopnea index (AHI), and nighttime minimum oxygen saturation (lowest SaO2min) improved in patients with OSAHS from before to after treatment ([Formula: see text]). The improvements were more profound in OSAHS patients with cardiovascular disease such as hypertension. Conclusion: The IoT medical technology can help to hierarchically diagnose, treat, and manage patients with OSAHS. It is feasible for primary hospitals in rural regions to use the IoT technology for the hierarchical diagnosis and treatment of OSAHS patients.

scholarly journals Dysfunction of Nrf2-ARE Signaling Pathway: Potential Pathogenesis in the Development of Neurocognitive Impairment in Patients with Moderate to Severe Obstructive Sleep Apnea-Hypopnea Syndrome

2018 ◽  
Vol 2018 ◽  
pp. 1-15 ◽  
Author(s):  
Li Zhou ◽  
Ruoyun Ouyang ◽  
Hong Luo ◽  
Yating Peng ◽  
Ping Chen ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Signaling Pathway ◽  
Neurocognitive Impairment ◽  
Apnea Hypopnea Index ◽  
Heme Oxygenase 1 ◽  
Severe Obstructive Sleep Apnea ◽  
Obstructive Sleep ◽  
Hypopnea Syndrome ◽  
Nrf2 Protein

The present study investigated the nuclear factor erythroid 2-related factor 2- (Nrf2-) antioxidant response element (ARE) signaling pathway in patients with moderate to severe obstructive sleep apnea-hypopnea syndrome (OSAHS). Their correlation with neurocognitive impairment metrics was investigated to explore potential pathogenesis in OSAHS. Forty-eight patients with OSAHS and 28 controls underwent testing with the Epworth Sleep Scale (ESS), MATRICS Consensus Cognitive Battery (MCCB), Stroop Color and Word Test, polysomnography (PSG), and measurements of the concentration of plasma superoxide dismutase (SOD) and thioredoxin (Trx). Further, 20 pairs of matched patients with OSAHS and controls were selected for measurement of the expression (protein and mRNA) of Nrf2 and of its downstream antioxidase, heme oxygenase-1 (HO-1), in peripheral mononuclear cells (PBMCs). Finally, correlations between neurocognitive impairment and the above metrics were analyzed. Expression of Nrf2 and HO-1 mRNA and protein in the PBMCs, as well as plasma SOD and Trx levels, were significantly reduced in patients with OSAHS. After adjusting for education, sex, age, and smoking index, the expression of Nrf2-ARE signaling pathway proteins (or mRNA) was closely correlated with sleep respiratory parameters. An inverse relationship was demonstrated between the expression of nuclear Nrf2 in PBMCs, concentration of plasma SOD and Trx, and apnea-hypopnea index (AHI) in patients with OSAHS. Trx, nuclear Nrf2 protein, and HO-1 protein were also negatively correlated with the percent of time that SaO2 was less than 90% (TSat90). Total Nrf2 protein level was positively correlated with AHI and TSat90 and negatively correlated with minimum SaO2 (LSaO2), while nuclear Nrf2 protein and HO-1 protein were positively correlated with LSaO2. Moreover, significant positive correlations were found between maze scores and expression of nuclear Nrf2 protein, HO-1 protein, and SOD and Trx levels. Furthermore, inverse relationships between total Nrf2 protein in PBMCs and HVLT-R and maze scores were found. Multiple linear regression showed plasma Trx concentration as a potential predictor of maze and BVMT-R scores. In conclusion, the expression of Nrf2-ARE molecules and related antioxidases is significantly decreased in patients with OSAHS and is correlated with neurocognitive dysfunction. The Nrf2-ARE signaling pathway may play a crucial role in neurocognitive impairment in patients with moderate to severe OSAHS. Further studies are needed to explore the exact mechanisms and potential treatment interventions.

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