Risk of Cerebrovascular Diseases After Uvulopalatopharyngoplasty in Patients With Obstructive Sleep Apnea

Chen, Shin Yan; Cherng, Yih-Giun; Lee, Fei Peng; Yeh, Chun Chieh; Huang, Shih-Horng; Hu, Chaur‐Jong; Liao, Chien-Chang; Chen, Ta-Liang

doi:10.1097/md.0000000000001791

Cited by 20 publications

(24 citation statements)

References 43 publications

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“…Two studies assessed CPAP [73,74]. Two studies assessed the effect of uvulopalatopharyngoplasty (UPPP) [75] or tracheostomy [76].…”

Section: Results Of Literature Searchmentioning

confidence: 99%

“…UPPP was associated with a significant decrease in the incidence of ischaemic (0.30% versus 1.76%, p<0.0001) and haemorrhagic (0.07% versus 0.47%, p<0.0001) stroke; relative risk reduction after adjustments for age, sex, low income, medical comorbidities and medication was 0.41 (95% CI 0.27-0.62) and 0.53 (95% CI 0.38-0.73), respectively [75]. Limitations of that study include the relatively small number of older patients, unknown OSA severity (insurance reimbursement claims) and absence of data on possible CPAP treatment in the non-UPPP treated population.…”

Section: Overview Of the Evidencementioning

confidence: 96%

“…HALLE et al [70] have reviewed the effect of the surgical treatment of OSA on cardiovascular outcomes. Only two studies, amongst the 33 included, reported stroke as an outcome; one was assessing UPPP and another was assessing tracheostomy (table e4) [75,76].…”

Section: Overview Of the Evidencementioning

confidence: 99%

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EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

et al. 2020

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@ERSpublicationsEvidence suggests a bidirectional relationship between sleep and stroke. However, the pathophysiological base of the associations and the possibilities of improving prevention and outcome through sleep-related interventions require further evaluation.ABSTRACT Sleep disorders are highly prevalent in the general population and may be linked in a bidirectional fashion to stroke, which is one of the leading causes of morbidity and mortality.Four major scientific societies established a task force of experts in neurology, stroke, respiratory medicine, sleep medicine and methodology, to critically evaluate the evidence regarding potential links and the impact of therapy. 13 research questions were evaluated in a systematic literature search using a stepwise hierarchical approach: first, systematic reviews and meta-analyses; second, primary studies postdating the systematic reviews/meta-analyses. A total of 445 studies were evaluated and 88 included. Statements were generated regarding current evidence and clinical practice.Severe obstructive sleep apnoea (OSA) doubles the risk for incident stroke, especially in young to middle-aged patients. Continuous positive airway pressure (CPAP) may reduce stroke risk, especially in treatment-compliant patients. The prevalence of OSA is high in stroke patients and can be assessed by polygraphy. Severe OSA is a risk factor for recurrence of stroke and may be associated with stroke mortality, while CPAP may improve stroke outcome. It is not clear if insomnia increases stroke risk, while pharmacotherapy of insomnia may increase it. Periodic limb movements in sleep (PLMS), but not restless limb syndrome (RLS), may be associated with an increased risk of stroke. Preliminary data suggest a high frequency of post-stroke insomnia and RLS and their association with a less favourable stroke outcome, while treatment data are scarce.Overall, the evidence base is best for OSA relationship with stroke and supports active diagnosis and therapy. Research gaps remain especially regarding insomnia and RLS/PLMS relationships with stroke. This article has an editorial commentary: https://doi.

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“…Two studies assessed CPAP [73,74]. Two studies assessed the effect of uvulopalatopharyngoplasty (UPPP) [75] or tracheostomy [76].…”

Section: Results Of Literature Searchmentioning

confidence: 99%

Section: Overview Of the Evidencementioning

confidence: 96%

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EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

et al. 2020

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“…8 PSG is a device that can show brain electrical activity, respiration, oxygen saturation during sleep and the severity of OSAS measured by Apnea-Hypopnea Index (apnea-hypopnea index, AHI). [9][10][11] Apart from all clinical and scientific advances regarding OSAS, most (70-90%) people affected by OSAS remain undiagnosed. 6 Lack of patient awareness, medical personnel have not received the training needed to help speed up case finding, and the high price of PSG examinations as gold OSAS standards are the cause of many undiagnosed OSAS patients.…”

Section: Introductionmentioning

confidence: 99%

The correlation of upper airway abnormalities with obstructive sleep apnea syndrome in young adult

Mardalita

Noventi

Marliyawati

et al. 2020

Intisari Sains Medis

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Background: Obstructive Sleep Apnea Syndrome (OSAS) is one of sleep disorder characterised by repeated episodes of total obstruction in the upper airway system during sleep. The incidence of OSAS is estimated to be 1-10% of general population. OSAS can be affected by several risk factors. One of risk factor of OSAS is upper airway abnormalities. The study aims to find out the association between individual risk factor including septum deviation, nasal turbinate hypertrophy, tonsillar hypertrophy and mallampati score with the incidence of OSAS in young adults.Methods: Analytic observational research with case-control design was carried out on young adults aged 18-23 years in the city of Semarang during May - September 2018 grouped into OSAS and non-OSAS based on Polysomnography (PSG), then history and physical examination were performed. Statistical tests were using chi-square, Fisher's exact test, and logistic regression.Result: Total of 22 people were included in OSAS group and 22 were included in the control group. Bivariate analysis showed septum deviation (p= 0.005), tonsillar hypertrophy (p=0.015) and mallampati score (p<0.001) significantly related to the incidence of OSAS, whereas nasal turbinate hypertrophy was not associated with OSAS incident. The results of multivariate analysis found that BMI had an OR value of 133 (95% CI 12.726 â€“ 1390.002, p<0.001) independently associated with the occurrence of OSAS in young adults.Conclusion: Septal deviation, tonsillar hypertrophy, mallampati score are the risk factors for OSAS in young adults.

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“…In a nationwide cohort study, patients with OSA had a lower risk of cerebrovascular disease 1 year after uvulopalatopharyngoplasty as compared with patients who did not undergo uvulopalatopharyngoplasty. 8 Combinations of palate surgery with various hypopharyngeal procedures were reported to achieve a response for 35% to 73% of patients, resulting in improved but imperfect outcomes for a number of patients. 9,10 The prerequisite for surgical success for OSA is to identify the sites of obstruction in the UA.…”

mentioning

confidence: 99%

Drug‐Induced Sleep Computed Tomography–Directed Upper Airway Surgery for Obstructive Sleep Apnea: A Pilot Study

Lee

Huang

et al. 2018

Otolaryngol.--head neck surg.

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Objective A surgical response to upper airway (UA) surgery for obstructive sleep apnea (OSA) depends on adequate correction of collapsible sites in the UA. This pilot study aimed to examine the surgical response to UA surgery directed by drug-induced sleep computed tomography (DI-SCT) for OSA. Study Design Prospective case series. Setting Tertiary referral center. Subjects and Methods This study recruited 29 OSA patients (median age, 41 years; median body mass index, 26.9 kg/m) who underwent single-stage DI-SCT-directed UA surgery between October 2012 and September 2014. DI-SCT was performed with propofol for light sedation with a bispectral monitor before and after UA surgery. Nonresponders were defined as those with a reduction in apnea-hypopnea index <50% after 6 months following UA surgery. Results DI-SCT showed that 28 (97%) patients had collapses at multiple sites, all of whom underwent multilevel UA surgery accordingly. The apnea-hypopnea index decreased from 53.6 to 26.8 ( P < .001). There were 18 (62%) nonresponders and 11 (38%) responders. Multiple-site collapses could not predict surgical response ( P > .99). The nonresponders had significant improvements in velopharyngeal, oropharyngeal lateral wall, and tongue collapses (all P < .05), whereas the responders had significant improvements in velopharyngeal and oropharyngeal lateral wall collapses (both P ≤ .05). Conclusion Despite multilevel OSA surgery, residual UA obstruction in nonresponders likely occurs due to multiple mechanisms. DI-SCT may help to elucidate the reasons for a nonresponse.

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Risk of Cerebrovascular Diseases After Uvulopalatopharyngoplasty in Patients With Obstructive Sleep Apnea

Cited by 20 publications

References 43 publications

EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

The correlation of upper airway abnormalities with obstructive sleep apnea syndrome in young adult

Drug‐Induced Sleep Computed Tomography–Directed Upper Airway Surgery for Obstructive Sleep Apnea: A Pilot Study

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