We analyzed the role of sleep position in obstructive sleep apnea syndrome (OSAS). The polysomnograms of 120 patients with sleep apnea syndrome were analyzed. We associated the apnea hypopnea index (AHI) of the supine position with the AHI of the other positions. Patients were stratified in a group of positional patients (PP) (AHI supine >or= 2 x AHI other positions) and a group of non-positional patients (NPP). In 55.8% of our patients, OSAS was position dependent. PP patients were significantly (6.7 years) younger. BMI and AHI were higher in the NPP group, but the difference was not significant. Level of obstruction in the upper airway (retropalatinal vs retrolingual vs both levels) as assessed by sleep endoscopy was not significantly different between the two groups. Total sleep time (TST) was equal in both groups, but the average time in supine position was 37 min longer in the PP group. This study confirms the finding that in more than 50% of patients, OSAS is position dependent. Apart from age, no patient characteristics were found indicating the position dependency. Overall AHI does not identify positional OSAS.
We evaluated the surgical results of a one tempo multilevel surgical approach of the upper airway to treat patients with obstructive sleep apnea syndrome (OSAS) in a prospective case series. Twenty-two patients with OSAS and obstruction at both palatinal and tongue base level, as assessed by sleep endoscopy, underwent UPPP, RFTB, HS with or without GA in one operative session. The mean apnea hypopnea index (AHI) decreased from 48.7 (range 17.4-100.9) to 28.8 (P < 0.0001). The success rate (AHI <20 and >50% reduction in AHI) was 45%, the response rate (reduction in AHI of 20-50%) was 27%. The overall response rate was 72%. The success rates of patients with an AHI <55 and >55 were 56 and 0%, respectively. The overall response rate of patients with an AHI <55 was 78% and >55 was 50%. Improvement of desaturation index was significant from 31.9 to 17.6 (P < 0.0001). Visual analogue scales for snoring and hypersomnolence and the Epworth Sleepiness Scores showed significant improvements too (all P < 0.0001). There was no difference in objective and subjective outcomes between the group with and without GA. This study demonstrates that one stage multilevel surgery, in which genioglossus advancement is not of additional value, is a valuable addition to the therapeutic armentarium and can be considered a viable alternative, objective as well as subjective, to NCPAP or as primary treatment in well selected patients with moderate to severe OSAS with an AHI <55.
We assessed adverse events and complications of bipolar radiofrequency induced thermotherapy of the tongue base (RFTB) in patients with socially unacceptable snoring (SUS) or obstructive sleep apnea syndrome (OSAS) and determine its acceptance and effectiveness when conducted under local anesthesia. This investigation consisted of (1) a prospective, open-enrollment study of 24 consecutive patients with snoring and OSAS at the tongue base level only (Fujita III), assessed by sleep endoscopy. Polysomnography, questionnaires, and visual analog scales (VAS) were used to assess outcome. (2) In addition, a retrospective review of 83 patients, who underwent RFTB (in 59 cases as part of a multilevel treatment), was performed to evaluate adverse events and complications. Twenty-two of the 24 patients completed postoperative questionnaires and VAS, and ten patients had postoperative polysomnography. Reduction in snoring (P = 0.0003), hypersomnolence (P = 0.002), and globus (P = 0.031) was significant. A positive trend in AHI (P = 0.001, n = 3) is shown in patients with moderate to severe OSAS. Concerning postoperative adverse events and complications, only two patients had a mild and transient tongue deviation directly after the procedure, which resolved within an hour postoperatively (adverse event rate 1.8%). No postoperative complications such as infections, abscesses, hematomas, or ulcerations of the tongue base occurred. This study demonstrates that bipolar RFTB in patients with obstruction at the tongue base only (Fujita type III) as visualized by sleep endoscopy is a safe and simple procedure under local anesthesia and can be effective in patients with SUS. No complications during this study were observed. Its effect on OSAS has been shown by other authors, although long-term effects are not stable. The RFTB can be considered as first choice treatment in case of snoring and mild OSAS in Fujita type III obstruction. In the case of moderate to severe sleep apnea, RFTB can be considered as an additional treatment.
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