EFFECTS OF UPPP ON SLEEP APNEA SYNDROME
We studied the therapeutic efficacy of uvulopalatopharygoplasty (UPPP) using apnea-hypopnea index (AHI) in cases diagnosed as obstructive sleep apnea syndrome and treated with UPPP, and report results comparing factors related to UPPP usefulness by classifying patients into complete and incomplete r...
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| Published in | JIBI INKOKA TEMBO Vol. 47; no. 3; pp. 153 - 157 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
Society of Oto-rhino-laryngology Tokyo
2004
耳鼻咽喉科展望会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0386-9687 1883-6429 |
| DOI | 10.11453/orltokyo1958.47.153 |
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| Abstract | We studied the therapeutic efficacy of uvulopalatopharygoplasty (UPPP) using apnea-hypopnea index (AHI) in cases diagnosed as obstructive sleep apnea syndrome and treated with UPPP, and report results comparing factors related to UPPP usefulness by classifying patients into complete and incomplete response groups. Subjects were 26 patients diagnosed with obstructive sleep apnea syndrome based on an overnight polysomnography (PSG) test and treated with UPPP from January 2001 to March 2003 and who underwent overnight PSG tests after surgery. Of these, 19 (73.1%) showing improvement exceeding 50% in postoperative AHI, among whom 11 (42.3%) showed a complete response, i.e., AHI improvement exceeding 50% and postoperative AHI of less than 10 times/hour. Incomplete response was seen in 15 (57.7%), i.e., AHI improvement of less than 50% or postoperative AHI of not less than 10 times/hour. The complete response group showed a significantly greater facial axis, reflecting simultaneous leptoprosopia and retrusion, in cephalometric analysis and was significantly younger than the incomplete response group. In addition, the highest hit ratio of 80.8% in predicting therapeutic efficacy by choosing complete or incomplete response was obtained when the cutoff facial axis was arbitrarily set to 84° and age to 42 years old. We concluded that a high UPPP efficacy may be expected in those with a facial axis of not less than 84° and aged not more than 42 years old. Further factors may affect the severity of sleep apnea syndrome and these should also be taken account in diagnosis and therapy. |
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| AbstractList | We studied the therapeutic efficacy of uvulopalatopharygoplasty (UPPP) using apnea-hypopnea index (AHI) in cases diagnosed as obstructive sleep apnea syndrome and treated with UPPP, and report results comparing factors related to UPPP usefulness by classifying patients into complete and incomplete response groups. Subjects were 26 patients diagnosed with obstructive sleep apnea syndrome based on an overnight polysomnography (PSG) test and treated with UPPP from January 2001 to March 2003 and who underwent overnight PSG tests after surgery. Of these, 19 (73.1%) showing improvement exceeding 50% in postoperative AHI, among whom 11 (42.3%) showed a complete response, i.e., AHI improvement exceeding 50% and postoperative AHI of less than 10 times/hour. Incomplete response was seen in 15 (57.7%), i.e., AHI improvement of less than 50% or postoperative AHI of not less than 10 times/hour. The complete response group showed a significantly greater facial axis, reflecting simultaneous leptoprosopia and retrusion, in cephalometric analysis and was significantly younger than the incomplete response group. In addition, the highest hit ratio of 80.8% in predicting therapeutic efficacy by choosing complete or incomplete response was obtained when the cutoff facial axis was arbitrarily set to 84° and age to 42 years old. We concluded that a high UPPP efficacy may be expected in those with a facial axis of not less than 84° and aged not more than 42 years old. Further factors may affect the severity of sleep apnea syndrome and these should also be taken account in diagnosis and therapy.
今回我々は, 閉塞性睡眠時無呼吸症候群と診断され口蓋垂口蓋咽頭形成術 (UPPP) を施行した症例を, 無呼吸低呼吸指数 (AHI) を用いて治療効果を判定するとともに著効群と非著効群に分類し, 口蓋垂口蓋咽頭形成術の効果に影響を及ぼす要因について比較検討したので報告する。対象は2001年1月から2003年3月までに, 終夜polysomnography (終夜PSG) にて閉塞性睡眠時無呼吸症候群と診断され, UPPPを施行しかつ術後終夜polysomnography検査を施行できた症例26例である。結果は著効例 (無呼吸低呼吸数の改善率が50%以上かつ術後無呼吸低呼吸数が10回/時未満) が11例 (42.3%), 非著効例 (無呼吸低呼吸数の改善率が50%未満または術後無呼吸低呼吸数が10回/時以上) が15例 (57.7%) であった。著効例は非著効例に比べ, セファロメトリー解析において頭蓋底に対する下顎の後退を示すfacial axisが有意に大きく (下顎がより前方に位置する), 年齢が有意に低かった。また, 任意にカットオフ値としてfacial axis84°かつ年齢42歳として治療効果を予想した場合, 著効, 非著効の的中精度が80.8%と最も高かった。したがって我々の施設において口蓋垂口蓋咽頭形成術は, facial axisが84°以上かつ年齢が42歳以下の症例に対して有効性が高いと考えられた。睡眠時無呼吸症候群の重症度に影響を及ぼす要因は様々であり, 総合的に診断, 治療を行う必要があると考える。 We studied the therapeutic efficacy of uvulopalatopharygoplasty (UPPP) using apnea-hypopnea index (AHI) in cases diagnosed as obstructive sleep apnea syndrome and treated with UPPP, and report results comparing factors related to UPPP usefulness by classifying patients into complete and incomplete response groups. Subjects were 26 patients diagnosed with obstructive sleep apnea syndrome based on an overnight polysomnography (PSG) test and treated with UPPP from January 2001 to March 2003 and who underwent overnight PSG tests after surgery. Of these, 19 (73.1%) showing improvement exceeding 50% in postoperative AHI, among whom 11 (42.3%) showed a complete response, i.e., AHI improvement exceeding 50% and postoperative AHI of less than 10 times/hour. Incomplete response was seen in 15 (57.7%), i.e., AHI improvement of less than 50% or postoperative AHI of not less than 10 times/hour. The complete response group showed a significantly greater facial axis, reflecting simultaneous leptoprosopia and retrusion, in cephalometric analysis and was significantly younger than the incomplete response group. In addition, the highest hit ratio of 80.8% in predicting therapeutic efficacy by choosing complete or incomplete response was obtained when the cutoff facial axis was arbitrarily set to 84° and age to 42 years old. We concluded that a high UPPP efficacy may be expected in those with a facial axis of not less than 84° and aged not more than 42 years old. Further factors may affect the severity of sleep apnea syndrome and these should also be taken account in diagnosis and therapy. |
| Author | Matsuwaki, Yoshinori Asaka, Daiya Hayama, Takashi Chiba, Shintaro Kojima, Junya |
| Author_FL | 浅香 大也 小島 純也 千葉 伸太郎 松脇 由典 葉山 貴司 |
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| References | 1) Guillminault C, Tikaian A : The sleep apnea syndromes. Annu Rev Med 27 : 465-485, 1976. 11) Young T, Palta M, Dempsey J, Skatrud J, Weber S, et al : The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328 : 1230-1235, 1993. 12) Haase A : Snapshot Flash MRI. Application to T1, T2 and chemical shift imaging. Magn Reson Med 13 : 77-89, 1990. 16) Ancoli-Israel S, Kripke DF, Klauber MR, Mason WJ, Fell R, et al : Sleep-disordered breathing in community-dwelling elderly. Sleep 14 : 486-495, 1991. 14) Larrson H, Carlsson-Nordlander B, Svanborg E : Long-time follow up after UPPP for obstructive sleep apnea syndrome. Acta Otolaryngol 111 : 582-590, 1991. 8) Rechtschaffen A, Kales A : A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. Public Health Service, U.S. Government Printing Office, Washington DC, 1968. 3) Sher AE, Schechtman KB, Piccirillo JF : The efficacy of surgical modification of the upper airway in adults with obstructive sleep apnea syndrome. Sleep 19 : 156-177, 1996. 2) 戸川清, 宮崎総一郎 : 手術的治療.睡眠時無呼吸症候群.本間日臣編, 克誠堂, 99-108, 2000. 7) 千葉伸太郎, 太田正治, 森脇宏人, 内田亮, 徳永雅一, 他 : 閉塞性睡眠時無呼吸症候群に対するn-CPAP療法と鼻手術の治療効果.耳展45 : 114-118, 2002. 6) He J, Kryger MH, Zorick H, Conway W, Roth T : Mortality and apnea index in obstructive sleep apnea experience in 385 male patients. Chest 94 : 9-14, 1988. 9) Chiba S, Sugisaki M, Tanabe H, Chiba S, Takahashi Y : Cephalometric analysis parameters related to the severity of sleep-breathing disorders. Sleep Biol Phythms 2 : 43-47, 2004. 10) Nezu H, Nagata K, Yoshida Y, Kosaka H, Kikuchi M : Cephalometric comparison of clinical norms between the Japanese and Caucasians. J Jpn Orthod Soc 4 : 450-465, 1982. 15) 岡本牧人, 望月高行 : 睡眠時無呼吸症候群におけるUvulopalatopharyngoplasty (U.P.P.P.) 術後長期観察例の検討.口咽科10 : 175-181, 1998. 5) Sullivan CE, Issa FG, Berthon-Jones M, Eves L : Reversal of obstructive sleep apnea by continuous positive airway pressure applied through the nares. Lancet 18 : 862-865, 1981. 13) 森脇宏人, 千葉伸太郎, 内田亮, 千葉幸子, 八木朝子, 他 : 睡眠呼吸障害の診断・評価におけるDynamic MRIの有用性.耳展46 : 144-150, 2003. 4) Pepin JL, Veale D, Mayer P, Bettega G, Wayam B, et al : Critical analysis of the result of surgery in the treatment of snoring upper airway resistance syndrome (OSA), and obstructive sleep apnea (OSA). Sleep 19 : 590-S100, 1996. |
| References_xml | – reference: 14) Larrson H, Carlsson-Nordlander B, Svanborg E : Long-time follow up after UPPP for obstructive sleep apnea syndrome. Acta Otolaryngol 111 : 582-590, 1991. – reference: 5) Sullivan CE, Issa FG, Berthon-Jones M, Eves L : Reversal of obstructive sleep apnea by continuous positive airway pressure applied through the nares. Lancet 18 : 862-865, 1981. – reference: 7) 千葉伸太郎, 太田正治, 森脇宏人, 内田亮, 徳永雅一, 他 : 閉塞性睡眠時無呼吸症候群に対するn-CPAP療法と鼻手術の治療効果.耳展45 : 114-118, 2002. – reference: 2) 戸川清, 宮崎総一郎 : 手術的治療.睡眠時無呼吸症候群.本間日臣編, 克誠堂, 99-108, 2000. – reference: 15) 岡本牧人, 望月高行 : 睡眠時無呼吸症候群におけるUvulopalatopharyngoplasty (U.P.P.P.) 術後長期観察例の検討.口咽科10 : 175-181, 1998. – reference: 12) Haase A : Snapshot Flash MRI. Application to T1, T2 and chemical shift imaging. Magn Reson Med 13 : 77-89, 1990. – reference: 11) Young T, Palta M, Dempsey J, Skatrud J, Weber S, et al : The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328 : 1230-1235, 1993. – reference: 4) Pepin JL, Veale D, Mayer P, Bettega G, Wayam B, et al : Critical analysis of the result of surgery in the treatment of snoring upper airway resistance syndrome (OSA), and obstructive sleep apnea (OSA). Sleep 19 : 590-S100, 1996. – reference: 9) Chiba S, Sugisaki M, Tanabe H, Chiba S, Takahashi Y : Cephalometric analysis parameters related to the severity of sleep-breathing disorders. Sleep Biol Phythms 2 : 43-47, 2004. – reference: 6) He J, Kryger MH, Zorick H, Conway W, Roth T : Mortality and apnea index in obstructive sleep apnea experience in 385 male patients. Chest 94 : 9-14, 1988. – reference: 1) Guillminault C, Tikaian A : The sleep apnea syndromes. Annu Rev Med 27 : 465-485, 1976. – reference: 16) Ancoli-Israel S, Kripke DF, Klauber MR, Mason WJ, Fell R, et al : Sleep-disordered breathing in community-dwelling elderly. Sleep 14 : 486-495, 1991. – reference: 13) 森脇宏人, 千葉伸太郎, 内田亮, 千葉幸子, 八木朝子, 他 : 睡眠呼吸障害の診断・評価におけるDynamic MRIの有用性.耳展46 : 144-150, 2003. – reference: 3) Sher AE, Schechtman KB, Piccirillo JF : The efficacy of surgical modification of the upper airway in adults with obstructive sleep apnea syndrome. Sleep 19 : 156-177, 1996. – reference: 10) Nezu H, Nagata K, Yoshida Y, Kosaka H, Kikuchi M : Cephalometric comparison of clinical norms between the Japanese and Caucasians. J Jpn Orthod Soc 4 : 450-465, 1982. – reference: 8) Rechtschaffen A, Kales A : A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. Public Health Service, U.S. Government Printing Office, Washington DC, 1968. |
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| Title | EFFECTS OF UPPP ON SLEEP APNEA SYNDROME |
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