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Beyond uvulopalatopharyngoplasty for obstructive sleep apnoea: single surgeon case series of contemporary airway reconstruction

Published online by Cambridge University Press:  13 December 2013

S G MacKay ,
N Jefferson  and
N S Marshall
S G MacKay*
Affiliation:
Department of Otolaryngology Head Neck Surgery, The Wollongong Hospital, Australia Graduate School of Medicine, University of Wollongong, Australia
N Jefferson
Affiliation:
Department of Otolaryngology Head Neck Surgery, The Wollongong Hospital, Australia
N S Marshall
Affiliation:
Sydney Nursing School, and the National Health and Medical Research Council Centre for Integrated Research and Understanding of Sleep, The University of Sydney, Australia
*
Address for correspondence: Associate Prof S G MacKay, 1–2, 8–10 Victoria St, Wollongong, NSW, Australia2500 Fax: +61 2 4227 6292 E-mail: sgmackay@ozemail.com.au
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Abstract

Objective:

Adult patients with obstructive sleep apnoea can be a therapeutic surgical challenge if other treatments fail or are rejected. We report the outcomes of a series of 17 patients for whom standard device-based treatments failed or could not be used. These patients were considered unsuitable for a lesser operation and therefore underwent multilevel upper airway reconstruction.

Method:

Data from 17 consecutive patients were collected prospectively. This included pre- and post-surgery findings for clinical assessments, body mass index, sleep questionnaires, and laboratory polysomnograms. Patients underwent a combination of modified uvulopalatopharyngoplasty, transpalatal advancement and various tongue reduction procedures.

Results:

Analyses revealed statistically and clinically significant reductions in: mean apnoea-hypopnoea index scores (from 36.3 pre-operatively to 14.5 post-operatively, p < 0.001), mean Epworth sleepiness scale scores (from 11.3 to 5.3, p < 0.001) and mean snoring severity scores (from 6.9 to 1.3, p < 0.001). Body mass index remained unchanged.

Conclusion:

Multilevel upper airway reconstructive surgery was associated with large reductions in both objective and patient-centred subjective measures of obstructive sleep apnoea severity.

Keywords

ObesityQuality Of LifePolysomnographyPatient ComplianceContinuous Positive Airway PressureReconstructive Surgical Procedures

Information

Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 127 , Issue 12 , December 2013 , pp. 1184 - 1189
Copyright
Copyright © JLO (1984) Limited 2013 

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Footnotes

Presented orally at the World Congress of Sleep Apnea (ENT Free Papers session 1), 27 August – 1 September 2012, Rome, Italy.

References

1Young, T, Peppard, PE, Gottlieb, DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 2002;9:1217–39CrossRefGoogle Scholar
2Punjabi, NM. The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc 2008;5:136–43CrossRefGoogle ScholarPubMed
3Marshall, NS, Wong, KKH, Liu, PY, Cullen, SRJ, Knuiman, MW, Grunstein, RR. Sleep apnea as an independent risk factor for all-cause mortality: the Busselton Health Study. Sleep 2008;31:1079–85Google ScholarPubMed
4Weaver, E. Judging sleep apnea surgery. Sleep Med Rev 2010;14:281–5CrossRefGoogle ScholarPubMed
5Weaver, TE, Grunstein, RR. Adherence to continuous positive airway pressure therapy: the challenge to effective treatment. Proc Am Thorac Soc 2008;5:173–8CrossRefGoogle ScholarPubMed
6Ravesloot, MJL, de Vries, N. Reliable calculation of the efficacy of non-surgical and surgical treatment of obstructive sleep apnea revisited. Sleep 2011;34:105–10CrossRefGoogle ScholarPubMed
7Caples, SM, Rowley, JA, Prinsell, JR, Pallanch, JF, Elamin, MB, Katz, SG et al. Surgical modifications of the upper airway for obstructive sleep apnea in adults: a systematic review and meta-analysis. Sleep 2010;33:1396–407CrossRefGoogle ScholarPubMed
8Elshaug, AG, Moss, JR, Hiller, JE, Maddern, GJ. Upper airway surgery should not be first line treatment for obstructive sleep apnoea in adults. BMJ 2008 5;336:44–5Google Scholar
9Haraldsson, PO, Carenfelt, C, Lysdahl, M, Tornros, J. Long-term effect of uvulopalatopharyngoplasty on driving performance. Arch Otolaryngol Head Neck Surg 1995;121:90–4CrossRefGoogle ScholarPubMed
10Marti, S, Sampol, G, Muñoz, X, Torres, F, Roca, A, Lloberes, P et al. Mortality in severe sleep apnea/hypopnea syndrome patients: impact of treatment. Eur Respir J 2002;20:1511–18CrossRefGoogle ScholarPubMed
11Weaver, EM, Maynard, C, Yueh, B. Survival of veterans with sleep apnea: continuous positive airway pressure versus surgery. Otolaryngol Head Neck Surg 2004;130:659–65CrossRefGoogle ScholarPubMed
12Epstein, LJ, Kristo, D, Strollo, PJ Jr, Friedman, N, Malhotra, A, Patil, SP et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 2009;15:263–76Google Scholar
13Robinson, S, Chia, M, Carney, AS, Chawla, S, Harris, P, Esterman, A. Upper airway reconstructive surgery long-term quality-of-life outcomes compared with CPAP for adult obstructive sleep apnea. Otolaryngol Head Neck Surg 2009;141:257–63CrossRefGoogle ScholarPubMed
14Riley, RW, Powell, NB, Guilleminault, C. Obstructive sleep apnea syndrome: a review of 306 consecutively treated surgical patients. Otolaryngol Head Neck Surg 1993;108:117–25CrossRefGoogle ScholarPubMed
15Friedman, M, Ibrahim, H, Joseph, NJ. Staging of obstructive sleep apnea/hypopnea syndrome: a guide to appropriate treatment. Laryngoscope 2004;114:454–9CrossRefGoogle ScholarPubMed
16Friedman, M. Sleep Apnea and Snoring: Surgical and Non-surgical Therapy. Philadelphia: Elsevier, 2009;11–13Google Scholar
17Fairbanks, DNF, Mickelson, SA, Woodson, BT. Snoring and Obstructive Sleep Apnea, 3rd edn.Philadelphia: Lippincott Williams and Williams, 2003;62–4Google Scholar
18Esmarch, F. Handbuch der Kriegschirurgischen Technik. Hannover: C. Rümpler, 1877;115–17Google Scholar
19Johns, MW. Sleepiness in different situations measured by the Epworth Sleepiness Scale. Sleep 1994;17:703–10CrossRefGoogle ScholarPubMed
20Johns, MW, Hocking, B. Daytime sleepiness and sleep habits of Australian workers. Sleep 1997;20:844–9CrossRefGoogle ScholarPubMed
21Lim, PV, Curry, AR. A new method for evaluating and reporting the severity of snoring. J Laryngol Otol 1999;113:336–40CrossRefGoogle ScholarPubMed
22Mackay, SG, Carney, SC, Woods, C, Antic, NA, McEvoy, RD, Chia, M et al. Modified uvulopalatopharyngoplasty and coblation channeling of the tongue for obstructive sleep apnea: a multi-centre Australian trial. J Clin Sleep Med 2013;9:117–24CrossRefGoogle ScholarPubMed
23Fairbanks, DNF, Mickelson, SA, Woodson, BT. Snoring and Obstructive Sleep Apnea, 3rd edn.Philadelphia: Lippincott Williams and Williams, 2003;160–6Google Scholar
24Zhang, Q, Song, W, She, C, Liu, D, Li, D, Zhang, X et al. Coblation-assisting uvulopalatopharyngoplasty combining coblation-channeling of the tongue for patients with severe OSAHS [in Chinese]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2012;26:114–17Google ScholarPubMed
25Friedman, M. Sleep Apnea and Snoring: Surgical and Non-surgical Therapy. Philadelphia: Elsevier, 2009;253–7Google Scholar
26MacKay, SG, Jefferson, N, Grundy, L, Lewis, R. Coblation-assisted Lewis and MacKay operation (CobLAMO): new technique for tongue reduction in sleep apnoea surgery. DOI:http://dx.doi.org/10.1017/S0022215113002971.CrossRefGoogle Scholar