Obese obstructive sleep apnea patients with tonsil hypertrophy submitted to tonsillectomy

Abstract

The physiopathology of obstructive sleep apnea-hypopnea syndrome (OSAHS) is multifactorial and obesity has been shown to be one of the main factors correlated with its occurrence. In obese patients with anatomical alterations of the upper airways it is often difficult to predict success for surgical correction since obesity is a limiting factor. Therefore, the aim of the present study was to evaluate the results of tonsillectomy in a specific group of patients, i.e., obese OSAHS patients with tonsil hypertrophy. Seven OSAHS patients with moderate obesity with obstructive palatine tonsil hypertrophy were submitted to tonsillectomy. All patients were submitted to pre-and postoperative appraisal of body mass index, otorhinolaryngology examination and polysomnography. Patients' average age was 36.4 ± 10.3 years and average preoperative body mass index was 36.6 ± 6.3 kg/m 2 . Postoperative weight did not differ significantly from preoperative weight (P = 0.27). Average preoperative apnea and hypopnea index (AHI) was 81 ± 26/h and postoperative AHI was 23 ± 18/h (P = 0.0005). Average preoperative minimum oxyhemoglobin saturation (SaO 2 min) was 69 ± 14% and the postoperative value was 83 ± 3% (P = 0.038). In relation to AHI, 6 (86%) of the 7 patients studied showed a reduction of 50% in relation to preoperative level and of these, 4 (57%) presented AHI of less than 20%. Only one patient presented a reduction of less than 50% in AHI, but even so showed improved SaO 2 min. Tonsillectomy treatment for OSAHS in obese patients with obstructive palatine tonsil hypertrophy caused a significant reduction in AHI, with improvement in SaO 2 min. This procedure could be eventually considered as an option of treatment for obese OSAHS patients with significant tonsil hypertrophy when continuous positive air pressure therapy is not possible as the first choice of treatment.

Tonsillectomy for adult obstructive sleep apnea: A systematic review and meta-analysis

“…67,68 Studies were excluded for the following reasons: only posttonsillectomy data was available, 24 no polysomnography or quantitative sleepiness data, 20,29,34,38,44,48,56,57,[60][61][62]64,65 the patient(s) underwent a tonsillectomy alone; however, the studies only reported data for the entire group which included additional surgeries, 28,41,[50][51][52][53] the patient(s) underwent another procedure simultaneously, 10,22,27,42,45,46,55,58,67,69 or the articles were review articles with no new data. 23,30 Seventeen studies 21,25,26,[31][32][33][35][36][37]39,40,42,49,54,…”

“…The study by Senchak et al was a prospective case‐control study with mostly young subjects (mean age 28 years) with mild or moderate OSA. Chen et al and Miyazaki et al had patients with a lower BMI (mean < 25 kg/m 2 ), whereas the patients in the studies by Houghton et al and Martinho et al had a higher overall BMI (33.3 kg/m 2 and 36.6 kg/m 2 , respectively). An additional variable that likely contributed to the overall heterogeneity includes the fact that only studies by Chen et al and Senchak et al were performed at multiple institutions, whereas the remaining studies were performed at single institutions.…”

Non-CPAP therapies in obstructive sleep apnoea

“…Despite significant improvements in respiratory parameters, there was evidence of residual sleep disordered breathing in most reports. More recent trials by MARTINHO et al [186] and NAKATA et al [187] investigated patients with OSA who where either intolerant to a CPAP trial or required high CPAP pressures to treat upper airway obstruction due to tonsillar hypertrophy. Based on these reports tonsillectomy play a role similar to nasal surgery in increasing the use of CPAP in patients with tonsillar hypertrophy, or when CPAP therapy is not possible as the first choice of therapy.…”

Simultaneous Tonsillectomy and Nasal Surgery in Adult Obstructive Sleep Apnea

“…A small number of studies have explored the role of tonsillectomy in selected adult cases, after unsuccessful CPAP treatment. [3][4][5] Success has been in the range of 40% to 100%, but subject numbers have been small. We present our experience with tonsillectomy and nasal surgery for OSA in selected adult subjects.…”