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

Xiong, Yuan; Yi, Hong; Yin, Shan; Meng, Li; Tang, Xiao; Guan, Jian; Luo, Hui; Zhang, Wei Tian; Cui, Bin

doi:10.1177/0194599811420811

Cited by 19 publications

(15 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In 2002, Friedman et al [18] developed a staging system to predict success in candidates for OSAHS surgery based on anatomic considerations; they then went on to demonstrate that the addition of a tongue base procedure (radiofrequency ablation) in stage II and III patients can have improved both objective (AHI) and subjective (Epworth Sleepiness Scale, ESS) outcomes. Although others have looked at predictors of success in OSAHS surgery [24], predictors of success in multilevel OSAHS surgery have not been forthcoming.…”

Section: Discussionmentioning

confidence: 99%

Body Mass Index Predicts Success in Patients Undergoing Transoral Robotic Surgery for Obstructive Sleep Apnea

Hoff

Glazer

Spector

2014

ORL

View full text Add to dashboard Cite

Objective: To determine the predictors of success in patients undergoing transoral robotic surgery (TORS) and multilevel procedures for the management of moderate-to-severe obstructive sleep apnea hypopnea syndrome (OSAHS). Methods: A total of 121 patients (83 male, 38 female) underwent TORS between 2010 and 2013. All patients had robotic assisted lingual tonsillectomy, either as stand-alone surgery or in combination with palatal Z-plasty, lateral pharyngoplasty or uvulopalatopharyngoplasty. The apnea-hypopnea index (AHI) and body mass index (BMI) were measured preoperatively and 3 months postoperatively. Success was defined as AHI <20 and a decrease in AHI by 50%. Results: There was a significant difference in the preoperative and postoperative AHI in the entire cohort (42.7 vs. 22.2; p < 0.001). Overall, 84.3% of patients had an improvement in their AHI, 51.2% of patients met the criteria for success, and 14% met the criteria for cure defined as AHI <5. When stratifying by BMI, there was a significant difference in success when comparing patients with a BMI <30 versus those with a BMI >30 (69.4 vs. 41.7%; p = 0.004). The cure rate was 15.3% in patients with a BMI <30 and 11.1% in those with a BMI >30 (p = 0.54). Conclusions: TORS lingual tonsillectomy and multilevel procedures were successful in treating moderate-to-severe OSAHS in selected patients. Preoperative BMI helps the clinician to predict success in these patients, with two thirds of patients having a clinically useful benefit. i 2014 S. Karger AG, Basel

show abstract

Section: Discussionmentioning

confidence: 99%

Body Mass Index Predicts Success in Patients Undergoing Transoral Robotic Surgery for Obstructive Sleep Apnea

Hoff

Glazer

Spector

2014

ORL

View full text Add to dashboard Cite

show abstract

“…While previous studies suggest responders to surgery typically have a lower BMI and AHI as well as certain anatomical features, [3][4][5][6][7][8][9] current predictive tools are not accurate enough for clinical use. For instance, surgical failure can result despite an apparently favorable preoperative anatomical milieu.…”

Section: Selecting Patients For Upper Airway Surgerymentioning

confidence: 95%

“…However, a significant number of patients who undergo surgery experience residual OSA 1,2 and predicting which patient is likely to respond to surgery is difficult. Several investigators have previously attempted to use anthropomorphic, 3 polysomnographic (PSG), 4,5 and anatomical [6][7][8][9] factors to predict success, but each of these do not have sufficient accuracy to be applied in clinical practice. 10 As such, there is significant motivation to better understand the mechanistic factors that determine surgery success and, as a result, to develop methods which reliably predict the patients who will respond favorably to upper airway surgery.…”

Section: Introductionmentioning

confidence: 99%

Loop Gain Predicts the Response to Upper Airway Surgery in Patients With Obstructive Sleep Apnea

Joosten

Leong

Landry

et al. 2017

Sleep

View full text Add to dashboard Cite

Study Objectives: Upper airway surgery is often recommended to treat patients with obstructive sleep apnea (OSA) who cannot tolerate continuous positive airways pressure. However, the response to surgery is variable, potentially because it does not improve the nonanatomical factors (ie, loop gain [LG] and arousal threshold) causing OSA. Measuring these traits clinically might predict responses to surgery. Our primary objective was to test the value of LG and arousal threshold to predict surgical success defined as 50% reduction in apnea-hypopnea index (AHI) and AHI <10 events/hour post surgery. LG remained a significant predictor of surgical success after controlling for covariates (logistic regression p = .018; receiver operating characteristic area under curve = 0.80). Conclusions: Our study provides proof-of-principle that upper airway surgery most effectively resolves OSA in patients with lower LG. Predicting the failure of surgical treatment, consequent to less stable ventilatory control (elevated LG), can be achieved in the clinic and may facilitate avoidance of surgical failures.

show abstract

“…These were tonsil size, the percentage of time with oxygen saturation below 90 % (CT 90 ), and the vertical distance between the lower edge of the mandible and the lower edge of the hyoid. A similar study also identified CT 90 , lowest SaO 2 , as well as AHI as significant predictive factors of surgical outcome [13]. However, none of those studies have included the data regarding the duration of respiratory events in their analyses.…”

Section: Resultsmentioning

confidence: 90%

“…Studies regarding the prediction of success in surgical treatment of OSA mostly evaluated the anatomic and anthropometric features, as well as AHI [10][11][12][13]. Data on the interaction between the duration of respiratory events and OSA surgery are sparse, and little is known.…”

Section: Introductionmentioning

confidence: 99%

The relationship between the duration of obstructive respiratory events and outcomes of multilevel upper airway surgery in patients with obstructive sleep apnea

Bostancı

Bozkurt

Turhan

2015

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

We aimed to examine whether the duration of respiratory events and related oximetric values are associated with outcomes of multilevel upper airway surgery in patients with moderate-severe obstructive sleep apnea (OSA). The records of patients with a preoperative apnea-hypopnea index (AHI) >15 events/h, who underwent uvulopharyngopalatoplasty plus tongue base suspension with or without septoplasty between 2012 and 2014, were reviewed retrospectively. If the postoperative 6th month AHI was <20 events/h with at least a 50 % reduction from preoperative rates, the outcome of surgery was regarded as successful, otherwise, as failure. To calculate factors predictive of surgical outcomes, a receiver operating characteristic (ROC) analysis was performed. Logistic regression analyses were utilized to obtain the Odds ratio (OR) and 95 % confidential interval (CI). In total, 82 patients were enrolled in the study. Sixty-one patients (74.4 %) met the success criteria. The mean obstructive apnea duration (OAD) was the sole variable with a significant and satisfactory area under the curve (AUC) value [AUC (95 % CI) = 0.719 (0.597-0.842), p = 0.003]. The cutoff value was found to be 26.75 s with 71.4 % sensitivity, 72.1 % specificity, 88.0 % positive predictive value, and 46.9 % negative predictive value. Univariate analysis revealed an association between surgical failure and mean OAD > 26.75 s, total apnea duration, lowest SaO2, mean SaO2, mean O2 desaturation, and oxygen desaturation index, although only mean OAD > 26.75 s remained to be an independent predictor for unfavorable outcome after adjustment for other confounders in multivariate analysis [OR (95 % CI) = 3.92 (1.08-14.17), p = 0.041]. The current study suggests that OSA patients having longer OAD are in the risk of having surgical failure.

show abstract

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

Abstract: Disease severity, glucose and lipid metabolism, and Friedman OSA stage may be important predictors of surgical outcome of UPPP for OSAHS.

Cited by 19 publications

References 30 publications

Body Mass Index Predicts Success in Patients Undergoing Transoral Robotic Surgery for Obstructive Sleep Apnea

Body Mass Index Predicts Success in Patients Undergoing Transoral Robotic Surgery for Obstructive Sleep Apnea

Loop Gain Predicts the Response to Upper Airway Surgery in Patients With Obstructive Sleep Apnea

The relationship between the duration of obstructive respiratory events and outcomes of multilevel upper airway surgery in patients with obstructive sleep apnea

Contact Info

Product

Resources

About