Minimally invasive tongue base surgery for obstructive sleep apnoea

Abstract

Moderate to severe obstructive sleep apnoea is usually associated with multiple levels of pharyngeal airway collapse, including tongue base obstruction. A new technique has recently been introduced that improves the nocturnal retro-lingual airway. This study was a prospective, non-randomized single-institution evaluation of a recently introduced surgical technique. Nineteen consecutive patients with previously untreated moderate to severe obstructive sleep apnoea underwent tongue suspension using the Respose system and concomitant palatopharyngoplasty (multilevel pharyngeal surgery). The patient demographics and treatment outcomes were prospectively collected and retrospectively analysed. There were 16 men and three women, with a mean (+/-SD) age of 44.9 years (+/- 14.2) and a mean pre-operative apnoea-hypopnoea index (AHI) of 42.8 +/- 24.8. Twelve of the 19 patients (63.2 per cent) have had post-operative polysomnography; eight of these 12 (67 per cent) met the standard criteria for surgical response. Among these eight patients, the AHI improved from 32.4 to 14.4 (p<0.01); the individual scores fell by a mean of 51.7 per cent. The apnoea index improved from 7.4 to 0.9 (p<0.01), with the individual scores falling by a mean of 81.4 per cent. There was anatomic and radiographic evidence of multilevel upper airway enlargement. Notably, the body mass index remained essentially unchanged (31.5 +/- 7.2 to 31.2 +/- 7.6, p>0.5). Subjectively, the mean Epworth sleepiness scale score fell from 11.0 +/- 5.4 to 5.4 +/- 3.8 (p<0.005). Four patients suffered transient velopharyngeal insufficiency, and two patients complained of limited anterior excursion of the tongue. There were no serious, long-term complications. The tongue suspension procedure represents a minimally invasive technique for improving the nocturnal retro-lingual airway in patients with obstructive sleep apnoea. It is easily performed by otolaryngologists, distinguishing it from other established techniques designed to address tongue base obstruction.

Identification of craniofacial risk factors for obstructive sleep apnoea using three-dimensional MRI

“…Thus surgical procedures that alter the position/size of the tongue may be more beneficial. Surgical procedures to reduce tongue volume have been introduced (36-38) but in these studies the effect on hyoid position was not addressed.…”

Non-CPAP therapies in obstructive sleep apnoea

“…A significant improvement in airway collapse at the palatal and tongue base level was demonstrated when Repose1 was combined with UPPP [295,297].…”

“…As the aim of the tongue suspension is to stabilise and support the tongue base, rather than to advance it, it not surprising that MILLER et al [296] and TERRIS et al [297] failed to find relevant changes in the posterior airway space. A significant improvement in airway collapse at the palatal and tongue base level was demonstrated when Repose1 was combined with UPPP [295,297].…”

Respiratory lumenal change of the pharynx and trachea in normal subjects and COPD patients: assessment by cine-MRI

“…Respiratory changes of the whole airways have clinical impact, e.g., in OSA [1][2][3][4], clinical importance, e.g., for monitoring of drug treatment in COPD and scientific effect, e.g., in ventilation modelling for drug deposition [14]. Table 1 Mean (range) of the minimal and maximal lumenal diameter within the palate (cm), the tracheal lumenal area (cm 2 ) and the relative collapse (%).…”

“…Obstructive sleep apnoea syndrome (OSA) [1][2][3][4], chronic obstructive pulmonary disease (COPD) [5][6][7][8], Wegener's granulomatosis [7], tracheobronchomalacia [7,9] and neoplasm [10] are known to affect the mechanical properties of the airways. Due to the significant difference of mural properties, at least the upper and lower airways have to be considered separately.…”