One stage multilevel surgery (uvulopalatopharyngoplasty, hyoid suspension, radiofrequent ablation of the tongue base with/without genioglossus advancement), in obstructive sleep apnea syndrome

Abstract

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.

Acceptance and long-term compliance of nCPAP in obstructive sleep apnea

“…[39,40] Many other surgical and non-surgical approaches are being explored as stand-alone therapy, or in combination. [41,42] Therefore, a gradual shift can be expected to take place to alternatives to nCPAP, being a combination of surgery, lifestyle alterations and if possible positional therapy, [43,44] in well- selected, well-informed patients, while nCPAP therapy in those patients will still be in reserve in case of failure.…”

Non-CPAP therapies in obstructive sleep apnoea

“…Many patients have had subjective alterations in taste immediately postoperatively, which resolved spontaneously. Rare complications included angina pectoris [381], dysphagia and cricopharyngeus, haematoma of the mouth floor [376] and long-lasting hypoglossal nerve paresis [374].…”

Single-Stage Multilevel Upper Airway Surgery in Patients with Severe Obstructive Sleep Apnea Syndrome

“…Nazal obstrüksiyonu olan hastalara eş zamanlı düzeltici nazal cerrahi yapıldı. Tüm bu cerrahiler literatürde önerildiği gibi başarıya giden yolun uzamaması için aynı seansta gerçekleştirildi (14). Bu kombine cerrahi tekniğin uygulandığı hastalardaki başarı oranımız % 74 olup, literatürdeki diğer çok seviyeli OSAS cerrahisi başarı oranlarına benzerdir (5).…”