The Effect of Upper Airway Structural Changes on Central Chemosensitivity in Obstructive Sleep Apnea-Hypopnea

Abstract

We examined the efficiency of upper airway structural changes in uvulopalatopharyngoplasty and/or tonsillectomy on central chemosensitivity, and whether the outcome of such surgeries can be predicted by the central chemosensitivity in obstructive sleep apnea-hypopnea syndrome (OSAHS) patients. In 11 patients with OSAHS group, the average of the hypercapnic ventilatory response (HCVR) slope was 1.93 +/- 0.20 L/min/mm Hg preoperatively and 1.78 +/- 0.22 L/min/mm Hg postoperatively. The average of the mouth occlusion pressure at 0.1 second after the onset of inspiration (P (0.1)) slope was 0.47 +/- 0.06 cm H (2)O/mm Hg and 0.44 +/- 0.08 cm H (2)O/mm Hg, before and after surgery, respectively. There were no significant differences before and after treatment, although OSAHS was improved by these surgeries. In control group with 5 patients, the HCVR slope and P (0.1) slope also showed no significant difference before and after the procedure. When we divided the 11 OSAHS patients into 7 responders (apnea-hypopnea index < 20 events/h and > 50% reduction) and 4 poor responders, there was a significant difference between the average HCVR slope of responders (1.59 +/- 0.21 L/min/mm Hg) and that of poor responders (2.52 +/- 0.20 L/min/mm Hg). We saw no significant difference in physiologic (age, body mass index, one-piece tonsil weight), blood gas values, cephalometric, spirometric, or sleep parameters.

Tonsillectomy for adult obstructive sleep apnea: A systematic review and meta-analysis

“…The searches yielded 2,318 studies: 47 were potentially relevant and were downloaded. References revealed two additional potentially relevant studies .…”

“…References revealed two additional potentially relevant studies. 67,68 Studies were excluded for the following reasons: only posttonsillectomy data was available, 24 no polysomnography or quantitative sleepiness data, 20,29,34,38,44,48,56,57,[60][61][62]64,65 the patient(s) underwent a tonsillectomy alone; however, the studies only reported data for the entire group which included additional surgeries, 28,41,[50][51][52][53] the patient(s) underwent another procedure simultaneously, 10,22,27,42,45,46,55,58,67,69 or the articles were review articles with no new data. 23,30 Seventeen studies 21,25,26,[31][32][33][35][36][37]39,40,42,49,54,<...>…”

Digital recording and analysis of esophageal pressure for patients with obstructive sleep apnea–hypopnea syndrome

“…On the other hand, the Pes swing at the inspiratory peak during sleep is an absolute value and rarely influenced by the differences in the scorers or methods of detection. Our previous study demonstrated that upper airway surgeries such as uvulopalatoplasty or tonsillectomy change apneas to hypopneas, reducing the Pes rather than AHI, suggesting that only AHI does not always reflect the severity of the disease in patients with OSAHS [8]. Pulse transit time is considered as a noninvasive alternative estimate of inspiratory effort; however, Arousal Index (events/h) 8 Fig.…”

Postoperative Monitoring of Esophageal Pressure in Patients with Obstructive Sleep Apnea-Hypopnea Syndrome Who Have Undergone Tonsillectomy with Uvulopalatopharyngoplasty

“…Tonsillectomy with uvulopalatopharyngoplasty (UPPP) is the most common surgery for OSAHS and is effective for carefully selected young, nonobese patients with normal craniofacial features but with hypertrophic tonsils. 1 Postoperative management is very important for OSAHS patients, because respiratory compromise due primarily to the potential loss of the airway has been encountered. [2][3][4] In accordance with the practice guidelines for the perioperative management of OSAHS patients established by the American Society of Anesthesiologists, patients with an increased risk of respiratory compromise from OSAHS should have continuous pulse oximetry monitoring while in bed.…”