Hostname: page-component-78c5997874-j824f Total loading time: 0 Render date: 2024-11-10T15:51:24.030Z Has data issue: false hasContentIssue false
  • English
  • Français

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
Get access Rights & Permissions [Opens in a new window]

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

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