Uvulopalatopharyngoplasty in Obstructive Apnea: Value of Preoperative Localization of Site of Upper Airway Narrowing during Sleep

Abstract

We hypothesized that those obstructive sleep apnea (OSA) patients with upper airway collapse during sleep within the transpalatal airway would have a more favorable response to uvulopalatopharyngoplasty (UPP) than those patients with obstruction within the hypopharyngeal airway. We tested this hypothesis in seven OSA patients with transpalatal and seven with hypopharyngeal obstruction undergoing UPP. Preoperatively the apnea/hypopnea index (AHI) was different between palatal and hypopharyngeal obstructors, 37.8 +/- 6.0 (+/- SEM) and 63.9 +/- 6.3, respectively (p less than 0.05), but the apnea-associated arterial oxygen desaturation and the lowest sleep saturation level were not different between the two groups. Postoperatively the AHI was 17.6 +/- 7.2 in the palatal obstructors and 40.3 +/- 15.6 in the hypopharyngeal obstructors (both p less than 0.05 from preoperative AHI). The palatal obstructors had a significant decrease in the percentage of sleep time spent apneic and the hypopharyngeal obstructors had a significant decrease in the hypopnea, but not apnea, time following surgery. The palatal obstructors had a significantly higher postoperative arterial oxygen saturation than the hypopharyngeal obstructors. Two hypopharyngeal obstructors worsened postoperatively. In addition we found that regardless of the site of the obstruction preoperatively, all obstructions occurred at the level of the palate postoperatively. We conclude that patients with preoperative transpalatal obstruction had diminution in obstructive apneas and those with hypopharyngeal obstruction had diminution in hypopneas but not apneas. Oxygenation was better postoperatively in the palatal obstructors, and none worsened postoperatively. These results suggest that identification of the site of upper airway obstruction in OSA may be beneficial.(ABSTRACT TRUNCATED AT 250 WORDS)

Polysomnography and ApneaGraph® in Patients with Sleep-Related Breathing Disorders

“…OSAS, as a form of SRBD, is recognized as a common clinical condition that is associated with increased cardiovascular and cerebrovascular morbidity and mortality [8,9] . OSAS is characterized by repetitive upper airway narrowing, or collapse of the velopharynx, oropharynx and/or hypopharynx, resulting in hypopneas and apneas.…”

Site of upper airway obstruction in obstructive apnoea and influence of sleep stage

“…UA pressure measurements provide information about UA dynamics in terms of changes in UA pressure before, during and after the appearance of respiratory events. Results from UA pressure measurements have been reported by several authors using different techniques varying from a fluid-filled catheter [5] to movable catheters [6,7], a bias flow catheter [8][9][10] and micropressure sensors [11][12][13][14][15]. Most studies were performed in a limited number of patients (n<20) except those of KATSANTONIS et al [15], SCATVEDT [13] and METES et al [7].…”

The value of posterior rhinomanometry in evaluating patients with snoring and obstructive sleep apnea syndrome

“…However, between the AHI value and nasal allergy (p = 0.06), tongue base (p = 0.05), the semi-elliptical/omega epiglottis shape (p = 0.05), we found a statistically significant relationship. Many studies argue that a deviated nasal septum, nasal polyps and nasal allergy are the most common changes involved in determining the severity of OSAS [7][8][9] . There is epidemiological data that takes into account the direct relationship between nasal congestion and obstructive sleep apnea [1][2][3] .…”