A study of sleep-disordered breathing and surgery outcome

• Published in: Stomato-pharyngology Vol. 25; no. 2; pp. 139 - 150
• Main Authors: Takane, Tomoyuki, Hisamatsu, Ken-ichi, Hirai, Ryoji, Makiyama, Kiyoshi, Kudou, Itsuhiro
• Format: Journal Article
• Language: Japanese
• Published: Japan Society of Stomato-pharyngology 2012; 日本口腔・咽頭科学会
• Subjects: coblation UPPP; endonasal rhinoplasty; obstructive sleep apnea hypopnea syndrome; posterior nasal nerve resection; upper airway resistance syndrome; 上気道抵抗症候群; 両側粘膜下下鼻甲介骨切除術; 後鼻神経切断術; 閉塞性睡眠時無呼吸低呼吸症候群; 鼻中隔矯正術および両側中鼻甲介部分切除術の複合手術
• ISSN: 0917-5105; 1884-4316
• DOI: 10.14821/stomatopharyngology.25.139

We evaluated the relationship of sleep-disordered breathing (SDB) to surgical outcome in 104 subjects-(83 men and 21 wemen)-aged 21 to 73 years old. The conditions evaluated were obstructive sleep apnea-hypopnea syndrome (OSAHS), upper airway resistance syndrome (UARS), snoring, and excessive daytime sleepiness. Treatment involved endonasal rhinoplasty (ER) consisting of septoplasty, bilateral submucosal inferior turbinectomy with posterior nasal nerve resection and bilateral partial middle turbinectomy, and/or coblation-assisted uvulopalatopharyngoplasty (cobUPPP) using a temperature-controlled radiofrequency bipolar wand. Three months later, the postoperative effect was evaluated using polysomnography with or without electroencephalography, the Epworth sleepiness scale (ESS), snoring (VAS), and nasal allergy symptoms if any. We divided SDB upper airway levels into A, nose and epipharynx, B, nasopharynx, including soft palate and tonsils; and C, hypo-pharynx, tongue, and tonguebase. We assumed that SDB pathophysiology involved factors (1) negatives pharyngeal pressure during sleep, (2) increased airflow volume, (3) narrow upper airway and wide posterior pillar, (4) upper airway weakness, and (5) obesity. ER reduces daytime and sleep nasal resistance which decreases negative pharyngeal pressure, and factor (1). cobUPPP directly improves factors (3) and (4). cobUPPP outcome was superior to ER in OSAHS, although these two staged operations had a better outcome than single surgeries in OSAHS, suspicious UARS, excessive daytime sleepiness, snoring, and improved respiratory events during sleep. Nonresponders in staged surgeries involved ER and cobUPPP, suggesting the influence of level C factor (3), the tongue, and/or the tongue base. These results suggest that SDB pathophysiology is attributable to upper airway multilevels together the influence of certain individual factors.