Upper airway surgery: the effect on nasal continuous positive airway pressure titration on obstructive sleep apnea patients

Zonato, Adriane Iurck; Bittencourt, Lia; Martinho, Fernanda Louise; Gregório, Luiz Carlos; Tufik, Sérgio

doi:10.1007/s00405-005-1018-y

Cited by 51 publications

(25 citation statements)

References 32 publications

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“…Only 3 studies discussed surgical complications [8,20,24]. Out of these, none observed major complications.…”

Section: Resultsmentioning

confidence: 99%

“…Eight studies were excluded due to lack of a comparison of pre- and postoperative CPAPs in patients after UAS. Of the 11 studies that met the inclusion criteria, 5 were retrospective [8,16,17,18,19], 4 were prospective [20,21,22,23], and 2 were RCTs [24,25]. UAS performed in the studies included nasal valve repair, radiofrequency ablation to the palate, turbinate reduction, septoplasty, Pillar implants, tonsillectomy, and UPPP.…”

Section: Resultsmentioning

confidence: 99%

“…A minimum of 4 h of nightly CPAP is recommended [5]. Unfortunately, adherence to CPAP therapy has long been an issue in treating sleep apnea [7,8,9]. It is estimated that up to 15% of patients discontinue CPAP after their first-night trial [10].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The Effect of Upper Airway Surgery on Continuous Positive Airway Pressure Levels and Adherence: A Systematic Review and Meta-Analysis

Ayers

Lohia

Nguyen

et al. 2016

ORL

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Background /Aims: The aim of this study was to determine the effect of upper airway surgery (UAS) on continuous positive airway pressure (CPAP). A secondary objective was to determine if a decrease in CPAP from UAS increases CPAP adherence. Methods: Studies were eligible for inclusion if a CPAP titration was performed both prior and following UAS in patients with obstructive sleep apnea (OSA). Studies that compared adherence to CPAP before and after UAS were included to evaluate the secondary objective. Results: A total of 11 articles involving 323 patients were included in the review. The results show that there was a mean reduction in CPAP of 1.40 cm H₂O (95% CI -2.08 to -0.73). Four of the 11 papers, with a total of 80 patients, evaluated CPAP adherence and found a significant 0.62-hour improvement on average (95% CI 0.22-1.01). Conclusion: Due to high levels of nonadherence, surgical intervention will play a role even in patients who are unlikely to be fully cured by surgery. UAS decreases the apnea-hypopnea index and modestly reduces CPAP while improving CPAP adherence in the majority of patients. The evidence suggests that UAS may have an adjunctive role in the management of OSA.

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“…Only 3 studies discussed surgical complications [8,20,24]. Out of these, none observed major complications.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

The Effect of Upper Airway Surgery on Continuous Positive Airway Pressure Levels and Adherence: A Systematic Review and Meta-Analysis

Ayers

Lohia

Nguyen

et al. 2016

ORL

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“…However, variable additional factors also impact CPAP compliance, such as individual perception of symptoms and improvement in sleepiness and daily function from initial use of CPAP. For these reasons, larger, well-designed studies are needed to confi rm the durability of any benefi cial effect on CPAP compliance from nasal surgical procedures for individuals with OSA (Zonato et al 2006 ;Weaver and Grunstein 2008 ;Friedman and Wilson 2009 ).…”

Section: Surgical Managementmentioning

confidence: 96%

Nose and Sleep Breathing Disorders

Poirrier

Eloy

Rombaux

2013

Nasal Physiology and Pathophysiology of Nasal Disorders

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• The nose is the input channel for the airfl ow. Its rigid and erectile structures determine the outline and the output of the airfl ow in the upper airway. Nose obstruction, due to reversible or nonreversible factors, produces collapsing forces that are manifest downstream in the collapsible pharynx. Moreover, nose pathologies result in unstable oral breathing, decreased activation of nasalventilatory refl ex and reduced lung nitric oxide. Long-term oral breathing impacts on the craniofacial growth. The management of nose pathologies could be medical, mechanical (nose dilators) or surgical. Nasal management should be integrated in a multimodal approach, considering the involvement of a multilevel obstruction, and truly refl ecting the complexity of sleep disordered breathing.

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“…7 Conversely, several studies have demonstrated that multilevel upper airway surgery may improve CPAP compliance and patient symptoms by significantly reducing mean CPAP pressures without observed increases in mask leakage. [8][9][10][11][12] The Pillar implant system is a tissue-sparing, minimally invasive treatment option for patients with snoring and mild levels of sleep apnea. The procedure demonstrates a high level of patient acceptance with low levels of postprocedure discomfort, as evidenced by the 76% of control patients in this study who decided to undergo the procedure a second time to receive the active implants.…”

Section: Discussionmentioning

confidence: 99%

Effect of Palatal Implants on Continuous Positive Airway Pressure and Compliance

Gillespie

Wylie

Lee‐Chiong

et al. 2010

Otolaryngol.--head neck surg.

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Objective. Determine if the Pillar palatal implant system reduces continuous positive airway pressure (CPAP) pressure and improves patient compliance with CPAP therapy.Study Design. Randomized, double-blind, placebo-controlled study.Setting. Four geographically dispersed tertiary sleep disorder referral centers.Methods. Subjects with mild to moderate sleep apnea dissatisfied with CPAP because of pressure-related complaints were randomized to receive Pillar implants or a sham procedure performed in double-blind fashion. Active and sham groups were compared for changes in therapeutic CPAP pressures (primary outcome) with a 90-day follow-up sleep study and CPAP compliance (secondary outcome) with a 90-day smart card report.Results. Twenty-six subjects were randomized to Pillar implants and 25 to a sham implant procedure. There were no differences between groups with regard to demographics and baseline parameters. Both sham and active groups had reduced mean CPAP pressure (−1.1 vs −0.5 cm H 2 O) with no difference between groups (P = .32) at 90-day follow-up. In addition, there was no difference in average daily CPAP use between groups (P = .80). Both groups experienced improvements in Epworth sleepiness scores and Functional Outcome of Sleep Questionnaire scores at 90 days with no differences between groups. The active group reported significantly higher CPAP satisfaction scores than the sham group (P = .04).Conclusion. Pillar implants do not significantly reduce CPAP pressure or increase CPAP compliance compared to sham controls but may subjectively improve CPAP satisfaction. These findings do not presently support the use of Pillar implants as an adjunctive treatment to improve CPAP compliance.

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Upper airway surgery: the effect on nasal continuous positive airway pressure titration on obstructive sleep apnea patients

Cited by 51 publications

References 32 publications

The Effect of Upper Airway Surgery on Continuous Positive Airway Pressure Levels and Adherence: A Systematic Review and Meta-Analysis

The Effect of Upper Airway Surgery on Continuous Positive Airway Pressure Levels and Adherence: A Systematic Review and Meta-Analysis

Nose and Sleep Breathing Disorders

Effect of Palatal Implants on Continuous Positive Airway Pressure and Compliance

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