Targeted surgery for obstructive sleep apnea

Česká verzia

Authors: J. Hanák; J. Rottenberg; B. Gál
Authors place of work: Klinika otorinolaryngologie a chirurgie hlavy a krku LF MU a FN u sv. Anny v Brně
Published in the journal: Cesk Slov Neurol N 2022; 85(2): 157-162
Category: Original Paper
doi: https://doi.org/10.48095/cccsnn2022157

Summary

Aim: The aim of this study was to evaluate the effectiveness of surgical treatment in patients with obstructive sleep apnea (OSA). We would like to ascertain in our study whether the targeted and personalized surgical treatment of OSA can achieve similar effectiveness of surgical treatment in all degrees of severity of OSA. Methods: The retrospective study included 65 adult patients who had undergone the basic ear, nose and throat examination, multi-channel polygraphy confirming the diagnosis of OSA and subsequent surgical treatment: uvulopalatopharyngoplasty or radiofrequency-assisted uvulopalatoplasty, uvulaflap, in combination with or without radiofrequency induced thermotherapy at the base of the tongue, and subsequent control multichannel polygraphy at 3–12 months after surgery. Results: It was confirmed that postoperatively all groups of patients reported a statistically significant reduction in apnea/ hypopnea index by 59% (P = 6.7x10–12) and reduction in desaturation by 57% (P = 3.2x10–5). The most effective surgical procedures were uvulopalatopharyngoplasty in combination with radiofrequency induced thermotherapy at the base of the tongue with the reduction of the apnea/ hypopnea index by 59% (P = 1.8x10–12) and reduction of desaturation by 51% (P = 0.001), and uvulopalatopharyngoplasty with the reduction of the apnea/ hypopnea index by 57% (P = 0.006) and reduction of desaturation by 85% (P = 0.07108). Conclusion: The surgical treatment of OSA shows very good effectiveness in all degrees of severity of OSA provided by the standardized diagnosis of the site of obstruction and when the surgical procedure is selected accordingly.

Keywords:

uvulopalatopharyngoplasty – tructive sleep apnea – hypopnea – desaturation – uvulopalatoplasty

Zdroje

1. Heinzer R, Vat S, Marques-Vidal P et al. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med 2015; 3(4): 310–318. doi: 10.1016/ S2213-2600(15)00043-0.

2. Marshall NS, Wong KK, Liu PY et al. Sleep apnea as an independent risk factor for all-cause mortality: the busselton health study. Sleep 2008; 31(8): 1079–1085.

3. Partinen M, Jamieson A, Guilleminault C. Long-term outcome for obstructive sleep apnea syndrome patients. Mortality. Chest 1988; 94(6): 1200–1204.

4. Young T, Finn L, Peppard PE et al. Sleep disordered breathing and mortality: eighteen-year followup of the wisconsin sleep cohort. Sleep 2008; 31(8): 1071–1078.

5. Wang X, Ouyang Y, Wang Z et al. Obstructive sleep apnea and risk of cardiovascular disease and all-cause mortality: a meta-analysis of prospective cohort studies. Int J Cardiol 2013; 169(3): 207–214. doi: 10.1016/ j.ijcard. 2013.08.088.

6. Shaw JE, Punjabi NM, Naughton MT et al. The effect of treatment of obstructive sleep apnea on glycemic control in type 2 diabetes. Am J Respir Crit Care Med 2016; 194(4): 486–492. doi: 10.1164/ rccm.201511-226 0OC.

7. Kapur VK, Auckley DH, Chowdhuri S et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med 2017; 13(3): 479–504. doi: 10.5664/ jcsm.6506.

8. Jonas DE, Amick HR, Feltner C et al. Screening for obstructive sleep apnea in adults: evidence report and systematic review for the US Preventive services task force. JAMA 2017; 317(4): 415–433. doi: 10.1001/ jama.2016.19635.

9. Young T, Evans L, Finn L et al. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep 1997; 20(9): 705–706.

10. Gottlieb DJ, Punjabi NM. Diagnosis and manage- ment of obstructive sleep apnea: a review. JAMA 2020; 323(14): 1389–1400. doi: 10.1001/ jama.2020.3514.

11. Weaver TE, Grunstein RR . Adherence to continuous positive airway pressure therapy: the challenge to effective treatment. Proc Am Thorac Soc 2008; 5(2): 173–178. doi: 10.1513/ pats.200708-119MG.

12. Sawyer AM, Gooneratne NS, Marcus CL et al. A systematic review of CPAP adherence across age groups: clinical and empiric insights for developing CPAP adherence interventions. Sleep Med Rev 2011; 15(6): 343–356. doi: 10.1016/ j.smrv.2011.01.003.

13. Betka J, Kubíčková J, Klozar J et al. Poruchy dýchání ve spánku – chirurgická léčba. 1. vyd. Havlíčkův Brod: Tobiáš 2019.

14. Bergler W, Maleck W, Baker-Schreyer A et al. The Mallampati Score. Prediction of difficult intubation in otolaryngologic laser surgery by Mallampati Score. Anaesthesist 1997; 46(5): 437–440. doi: 10.1007/ s001010050423.

15. Friedman M, Tanyeri H, La Rosa M et al. Clinical predictors of obstructive sleep apnea. Laryngoscope 1999; 109(12): 1901–1907. doi: 10.1097/ 00005537-199912000- 00002.

16. Berry RB, Budhiraja R, Gottlieb DJ et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the scoring of sleep and associated events: deliberations of the sleep apnea definitions task force of the american academy of sleep medicine. J Clin Sleep Med 2012; 8(5): 597–619. doi: 10.5664/ jcsm.2172.

17. De Vito A, Carrasco Llatas M, Ravesloot MJ et al. European position paper on drug-induced sleep endoscopy: 2017 Update. Clin Otolaryngol 2018; 43(6): 1541–1552. doi: 10.1111/ coa.13213.

18. Choi JH, Cho SH, Kim SN et al. Predicting outcomes after uvulopalatopharyngoplasty for adult obstructive sleep apnea: a meta-analysis. Otolaryngol Head Neck Surg 2016; 155(6): 904–913. doi: 10.1177/ 0194599816661481.

19. Pang KP, Baptista PM, Olszewska E et al. Does drug- -induced sleep endoscopy affect surgical outcome? A multicenter study of 326 obstructive sleep apnea patients. Laryngoscope 2020; 130(2): 551–555. doi: 10.1002/ lary.27987.

20. Kalhous J, Kordík J. Léky navozená spánková endoskopie – odpovídá lokální nález v horních cestách dýchacích závažnosti syndromu spánkové apnoe? Cesk Slov Neurol N 2021; 84/ 117(2): 179–182. doi: 10.48095/ cccsnn2021179.

21. Masárová M, Seko J, Plášek M et al. Význam spánkové endoskopie při titraci přetlakové ventilace – první výsledky. Cesk Slov Neurol N 2021; 84/ 117(2): 183–187. doi: 10.48095/ cccsnn2021183.

22. De Corso E, Fiorita A, Rizzotto G et al. The role of drug-induced sleep endoscopy in the diagnosis and management of obstructive sleep apnoea syndrome: our personal experience. Acta Otorhinolaryngol Ital 2013; 33(6): 405–413.

23. American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Practice guidelines for the perioperative management of patients with obstructive sleep apnea: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology 2014; 120(2): 268–286. doi: 10.1097/ ALN.00000000 00000053.

24. Shallik N. Anesthetic management for drug induced sleep endoscopy. Middle East J Anaesthesiol 2015; 23(2): 131–135.

25. Soares D, Sinawe H, Folbe AJ et al. Lateral oropharyngeal wall and supraglottic airway collapse associated with failure in sleep apnea surgery. Laryngoscope 2012; 122(2): 473–479. doi: 10.1002/ lary.22474.

26. Vanderveken OM, Maurer JT, Hohenhorst W et al. Evaluation of drug-induced sleep endoscopy as a patient selection tool for implanted upper airway stimulation for obstructive sleep apnea. J Clin Sleep Med 2013; 9(5): 433–438. doi: 10.5664/ jcsm.2658.

27. Koutsourelakis I, Safiruddin F, Ravesloot M et al. Surgery for obstructive sleep apnea: sleep endoscopy determinants of outcome. Laryngoscope 2012; 122(11): 2587–2591. doi: 10.1002/ lary.23462.

28. Hsu YS, Jacobowitz O. Does sleep endoscopy staging pattern correlate with outcome of advanced palatopharyngoplasty for moderate to severe obstructive sleep apnea? J Clin Sleep Med 2017; 13(10): 1137–1144. doi: 10.5664/ jcsm.6756.

29. Steinbichler TB, Bender B, Giotakis AI et al. Comparison of two surgical suture techniques in uvulopalatopharyngoplasty and expansion sphincter pharyngoplasty. Eur Arch Otorhinolaryngol 2018; 275(2): 623–628. doi: 10.1007/ s00405-017-4852-9.

30. Maurer JT. Surgical treatment of obstructive sleep apnea: standard and emerging techniques. Curr Opin Pulm Med 2010; 16(6): 552–558. doi: 10.1097/ MCP.0b013e 32833ef7ea.

31. Caples SM, Rowley JA, Prinsell JR et al. Surgical modifications of the upper airway for obstructive sleep apnea in adults: a systematic review and meta-analysis. Sleep 2010; 33(10): 1396–1407. doi: 10.1093/ sleep/ 33.10.1396.

32. Sommer UJ, Heiser C, Gahleitner C et al. Tonsillectomy with uvulopalatopharyngoplasty in obstructive sleep apnea. Dtsch Arztebl Int 2016; 113(1-02): 1–8. doi: 10.3238/ arztebl.2016.0001.

33. Stuck BA, Ravesloot MJL, Eschenhagen T et al. Uvulopalatopharyngoplasty with or without tonsillectomy in the treatment of adult obstructive sleep apnea – a systematic review. Sleep Med 2018; 50: 152–165. doi: 10.1016/ j.sleep.2018.05.004.

34. Sampol G, Muñoz X, Sagalés MT et al. Long-term efficacy of dietary weight loss in sleep apnoea/ hypopnoea syndrome. Eur Resp J 1998; 12(5): 1156–1159. doi: 10.1183/ 09031936.98.12051156.

35. Maurer JT, Stuck BA, Hein G et al. Treatment of obstructive sleep apnea with a new vest preventing the supine position. Dtsch Med Wochenschr 2003; 128(3): 71–75. doi: 10.1055/ s-2003-36658.

36. Ng JH, Yow M. Oral appliances in the management of obstructive sleep apnea. Sleep Med Clin 2019; 14(1): 109–118. doi: 10.1016/ j.jsmc.2018.10.012.