J Rhinol.  2017 May;24(1):20-25. 10.18787/jr.2017.24.1.20.

Study for Clinical Efficacy of Sleep Surgery in Treatment of Patients with Moderate-Severe Obstructive Sleep Apnea

• Lee WH
• Oh S
• Oh H
• Park YK
• Min SG
• Shin JH
• Kim HJ

• KMID: 2379785
• DOI: http://doi.org/10.18787/jr.2017.24.1.20

Abstract

BACKGROUND AND OBJECTIVES
Surgical treatment is considered as a secondary treatment option for obstructive sleep apnea (OSA). This study was performed to determine whether surgical treatment can be considered in patients with moderate-severe OSA as a treatment modality.
MATERIALS AND METHODS
A total of 127 patients with moderate-severe OSA were retrospectively enrolled. The anatomic narrowing sites were mainly evaluated using cephalometry and drug induced sleep endoscopy (DISE), and then multi-level surgeries were performed.
RESULTS
Both uvula and soft palate were the most frequent narrowing sites and a total of 110 patients showed upper airway narrowing more than two anatomic structures. A total of 79 patients (62.1%) were categorized as responders and 48 patients (39.1%) were non-responders. After multi-level sleep surgeries, patients' subjective symptoms and sleep parameters were significantly improved. However, AHI was not considerably decreased. Non-responders to sleep surgeries showed relatively higher rates of severe OSA and body mass index. Tongue base narrowing, incomplete corrections of nasal pathologies and soft palate were significant factors for lower success rates.
CONCLUSION
We estimate that sleep surgery might be a therapeutic option for moderate to severe patients with OSA. A delicate pre-operative evaluation for upper airway narrowing is necessary to adapt sleep surgery to these patients.

Keyword

Obstructive sleep apnea; Sleep surgery; Drug induced sleep endoscopy; Severity; Efficacy

MeSH Terms

Body Mass Index
Cephalometry
Endoscopy
Humans
Palate, Soft
Pathology
Retrospective Studies
Sleep Apnea, Obstructive*
Tongue
Treatment Outcome*
Uvula

Figure

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  Fig. 1. The obstruction site and its frequency through the DISE examination ( A), Total number of narrowing sites in each pa-tient ( B).

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  Fig. 2. Type of surgeries which were conducted to patients with moderate and severe OSA.

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  Fig. 3. Patients’complaints after surgery.

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  Fig. 4. The findings of anatomic structures in non-responders ( N=48) at 3 months after sleep surgeries.

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