Obstructive Sleep Apnea Syndrome: A Review of 306 Consecutively Treated Surgical Patients

Abstract

Three hundred six consecutively treated surgical patients with obstructive sleep apnea syndrome were evaluated from a group of 415 patients. One hundred nine patients were excluded because they failed to obtain a postoperative polysomnogram or were lost to followup. All patients received a physical examination, cephalometric analysis, fiberoptic examination, and polysomnography before treatment to document OSAS and determine the areas of obstruction. A two-phase surgical protocol was used for the reconstruction of the upper airway. Phase I surgery consisted of a uvulopalatopharyngoplasty (UPPP) for palatal obstruction and genioglossus advancement with hyoid myotomy-suspension for base of tongue obstruction. Failures of phase I were offered phase 2 reconstruction, which consisted of maxillary-mandibular advancement osteotomy. One hundred twenty-one patients were treated with nasal continuous positive airway pressure (CPAP) before surgery and this was the primary method of evaluating surgical success. Results were reported on the polysomnogram performed a minimum of 6 months after surgery and compared to the preoperative polysomnogram and the second night nasal CPAP study. The polysomnographic results included respiratory disturbance index (RDI), lowest oxyhemoglobin saturation (LSAT), and sleep architecture parameters. Surgery was considered a success if it was equivalent to nasal CPAP or the postoperative RDI was less than 20 with normal oxygenation. The overall success rate, which included patients that dropped from the protocol, was 76.5%, with a mean followup of 9.3 months (SD, 6.7). The preoperative RDI, nasal CPAP RDI, and postoperative RDI were 55.8 (SD, 26.7), 7.2 (SD, 5.4), and 9.2 (SD, 7.5), respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Long-Term Effectiveness and Safety of Maxillomandibular Advancement for Treatment of Obstructive Sleep Apnea

“…When CPAP adherence is defi ned as > 4 hours of nightly use, 46% to 83% of OSA Several short term observational studies show that maxillomandibular advancement surgery (MMA) may be a clinically effective alternative therapy for patients with moderate-to-severe OSA who are not effectively treated with CPAP. [19][20][21][22][23][24][25][26] MMA involves surgical facial advancement by concomitant maxillary and mandibular osteotomies, thus enlarging the caliber of the posterior upper airway space. Although the level of evidence is low, substantial and consistent short-term reductions in the apnea-hypopnea index (AHI) are observed following MMA.…”

Indicação inicial de tratamento em 60 pacientes com distúrbios ventilatórios obstrutivos do sono

“…Currently, the surgical treatment proposed tends to be a complementary procedure according to the case needs 30 .…”

Surgical Therapy of Obstructive Sleep Apnea: A Review

“…Generally, procedures that carry less severe risks and potential complications are performed initially. The Stanford group protocol reports a staged surgical success rate of 75 % in patients with mild-to-moderate OSA and 40 % in patients with severe OSA in phase I (palatal surgery alone or in combination with GA) to 95 % in phase II or facial skeletal surgery [53]. In some cases when soft tissue abnormalities are not considered to play a significant role, maxillomandibular advancement can be considered as the initial therapeutic option [45].…”

“…Evidence has shown that single-site surgery has a poor success rate when multilevel obstruction is present. By combining surgical treatment modalities to address multiple levels of obstruction, the success rates can reach as high as 95 % in staged surgical protocols [53].…”