Lateral oropharyngeal wall and supraglottic airway collapse associated with failure in sleep apnea surgery

Abstract

Objectives/Hypothesis To identify patterns of airway collapse during preoperative drug-induced sleep endoscopy (DISE) as predictors of surgical failure following multilevel airway surgery for patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Study Design Retrospective clinical chart review. Methods Medical records of patients who underwent site-specific surgical modification of the upper airway for treatment of OSHAS were reviewed. Patients were included in this study if they had a preoperative airway evaluation with DISE as well as preoperative and postoperative polysomnography. Airway obstruction on DISE was described according to airway level, severity, and axis of collapse. Severe airway obstruction was defined as >75% collapse on endoscopy. Surgical success was described as a postoperative apnea-hypopnea index (AHI) of <20 and a >50% decrease in preoperative AHI. Results A total of 34 patients were included in this study. The overall surgical success rate was 56%. Surgical success (n = 19) and surgical failure (n = 15) patients were similar with regard to age, gender, body mass index, preoperative AHI, Friedman stage, adenotonsillar grades, and surgical management. DISE findings in the surgical failure group demonstrated greater incidence of severe lateral oropharyngeal wall collapse (73.3% vs. 36.8%, P = .037) and severe supraglottic collapse (93.3% vs. 63.2%, P = .046) as compared to the surgical success group. Conclusions The presence of severe lateral pharyngeal wall and/or supraglottic collapse on preoperative DISE is associated with OSAHS surgical failure. The identification of this failure-prone collapse pattern may be useful in preoperative patient counseling as well as in directing an individualized and customized approach to the treatment of OSHAS.

Reoperation on patients with obstructive sleep apnea–hypopnea syndrome after failed uvulopalatopharyngoplasty

“…The reason for treatment failure using UPPP in these patients might be increased pharyngeal wall collapse. The study reported by Soares et al [16], that some of the patients with failed UPPP had got lower pharyngeal wall and supraglottic tissue collapse, was consistent with our speculation.…”

Changes in Site of Obstruction in Obstructive Sleep Apnea Patients According to Sleep Position

“…Lateral wall obstruction is considered to be the most dynamic structure of the upper airway and thus a major contributor of upper airway collapse in OSA patients. Soares and colleagues have shown that patients with lateral wall obstruction are associated with surgical failure [ 25 ]. Overall frequency of lateral wall collapse in our study was 70.6 % in the supine position which is higher than other reports with DISE (51.2 %) [ 18 ].…”

Dynamic upper airway collapse observed from sleep MRI: BMI-matched severe and mild OSA patients

“…There is a strong association between lateral pharyngeal wall collapse and severity of oxygen desaturation during DISE [26]. Soares et al also reported the presence of severe lateral pharyngeal wall on preoperative DISE is associated with sleep surgical failure [27]. The most effective surgical treatment for OSA besides a tracheostomy is maxillomandibular advancement [28,29].…”