The impact of modified tongue base suspension on CPAP levels in patients with severe OSA

Turhan, Murat; Bostancı, Aslı; Akdağ, Mehmet

doi:10.1007/s00405-014-3034-2

Cited by 16 publications

(21 citation statements)

References 15 publications

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“…The operating procedures for the mTBS were carried out as we reported in detail in our earlier report [6]. This procedure is a modification of the Repose System which was described by DeRowe et al [7] without the use of a screw.…”

Section: Methodsmentioning

confidence: 99%

Predicting the outcome of modified tongue base suspension combined with uvulopalatopharyngoplasty

Turhan

Bostancı

Bozkurt

2014

Eur Arch Otorhinolaryngol

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The purpose of this study was to investigate the relationship between various polysomnographic variables and the success of modified tongue base suspension combined with uvulopharyngopalatoplasty in patients with severe obstructive sleep apnea (OSA). A total of 90 patients who had apnea hypopnea index (AHI) >30 and had both oropharyngeal and hypopharyngeal obstruction were included in this prospective case series with planned data collection. All patients were assessed preoperatively and at the sixth postoperative month by polysomnography. The surgery was considered to be successful when a ≥50% reduction in the mean AHI to a final AHI of <20/h was obtained. Multiple logistic regression analyses were performed to determine the impact of variables on the surgical success. A total of 67 patients (74.4%) met the surgical success criteria. The univariate analysis revealed a relationship between success and AHI (P = 0.001), obstructive apnea duration (P = 0.001), sleep time with oxygen saturation below 90% (ST90) (P = 0.004), minimum O2 saturation (P = 0.0001), mean O2 saturation (P = 0.011), mean O2 desaturation (P = 0.0001), and oxygen desaturation index (P = 0.001). However, ST90 [OR (95% CI) = 1.40 (1.04-1.89), P = 0.023] was the only independent parameter predicting the surgical success in multivariate analysis. The ROC analysis revealed that the ST90 value of ≤36 min was the best cutoff value with 96.97% sensitivity (CI 89.5-99.6), 95.83% specificity (CI 78.9-99.9), 98.5% PPV (CI 91.6-100.0), and 92.0% NPV (CI 74.0-99.0). The stratification of patients with severe OSA according to the ST90 may allow better identification of patients in whom surgical success is probable.

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Section: Methodsmentioning

confidence: 99%

Predicting the outcome of modified tongue base suspension combined with uvulopalatopharyngoplasty

Turhan

Bostancı

Bozkurt

2014

Eur Arch Otorhinolaryngol

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“…Tongue base suspension with UPPP has had a 70% (20–88.9%) success rate in patients with OSA, and a long-term success rate of 78% when combined with nasal surgery 12 , 19 , 20 . However, the anatomical base selection of patients has been insufficiently explored; only one long-term study on tongue base suspension and pharyngeal surgery with a 2-year follow-up period reported a 52% success rate.…”

Section: Discussionmentioning

confidence: 99%

The effect of tongue base suspension with uvulopalato-pharyngoplasty on sleep quality in obstructive sleep apnea

Tsou

Huang

et al. 2018

Sci Rep

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The objective was to investigate whether tongue base suspension with uvulopalatopharyngoplasty (UPPP) is beneficial on polysomnography analysis for sleep quality in patients with obstructive sleep apnea (OSA) anatomically classified as Fujita type III (small tonsils and a bulky tongue base). In the retrospective study, the charts of 36 patients with OSA that underwent tongue base suspension with UPPP from 2012 through 2015 were reviewed. The surgical outcome measured according to Sher’s classification (AHI reduction > 50% and AHI < 20 per hour as success group, otherwise as failure group). The pre- and post-operative sleep quality parameters were evaluated, and the total sleep time changes were evaluated based on electroencephalography study, slow wave sleep, sleep efficiency, rapid eye movement sleep percentile, and Epworth sleep scale scores. Respiratory, the outcomes of polysomnography analysis were then compared between the successful surgery and surgical failure groups during a 1-year follow up. Total arousals and reduced respiratory arousal indices, along with unchanged periodic leg movement and spontaneous electroencephalography arousal indices, were observed in the successful surgery group but not in the surgical failure group. There were 66% resulted in surgical success by this surgery, and 34% as in failure group according to Sher’s criteria. Patient sleep quality was further improved by reducing the respiratory arousal index and increasing the rapid eye movement sleep percentile during the 1-year follow up.

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“…The width and mass of the tongue base, and its distance to the epiglottis was subjectively evaluated with flexible fiberoptic nasopharyngoscopy. UPPP was performed using the modified technique described by Shin et al [14], and TBS was carried out according to Turhan's technique [15]. Both procedures were performed during the same operative session.…”

Section: Methodsmentioning

confidence: 99%

The relationship between the duration of obstructive respiratory events and outcomes of multilevel upper airway surgery in patients with obstructive sleep apnea

Bostancı

Bozkurt

Turhan

2015

Eur Arch Otorhinolaryngol

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We aimed to examine whether the duration of respiratory events and related oximetric values are associated with outcomes of multilevel upper airway surgery in patients with moderate-severe obstructive sleep apnea (OSA). The records of patients with a preoperative apnea-hypopnea index (AHI) >15 events/h, who underwent uvulopharyngopalatoplasty plus tongue base suspension with or without septoplasty between 2012 and 2014, were reviewed retrospectively. If the postoperative 6th month AHI was <20 events/h with at least a 50 % reduction from preoperative rates, the outcome of surgery was regarded as successful, otherwise, as failure. To calculate factors predictive of surgical outcomes, a receiver operating characteristic (ROC) analysis was performed. Logistic regression analyses were utilized to obtain the Odds ratio (OR) and 95 % confidential interval (CI). In total, 82 patients were enrolled in the study. Sixty-one patients (74.4 %) met the success criteria. The mean obstructive apnea duration (OAD) was the sole variable with a significant and satisfactory area under the curve (AUC) value [AUC (95 % CI) = 0.719 (0.597-0.842), p = 0.003]. The cutoff value was found to be 26.75 s with 71.4 % sensitivity, 72.1 % specificity, 88.0 % positive predictive value, and 46.9 % negative predictive value. Univariate analysis revealed an association between surgical failure and mean OAD > 26.75 s, total apnea duration, lowest SaO2, mean SaO2, mean O2 desaturation, and oxygen desaturation index, although only mean OAD > 26.75 s remained to be an independent predictor for unfavorable outcome after adjustment for other confounders in multivariate analysis [OR (95 % CI) = 3.92 (1.08-14.17), p = 0.041]. The current study suggests that OSA patients having longer OAD are in the risk of having surgical failure.

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The impact of modified tongue base suspension on CPAP levels in patients with severe OSA

Cited by 16 publications

References 15 publications

Predicting the outcome of modified tongue base suspension combined with uvulopalatopharyngoplasty

Predicting the outcome of modified tongue base suspension combined with uvulopalatopharyngoplasty

The effect of tongue base suspension with uvulopalato-pharyngoplasty on sleep quality in obstructive sleep apnea

The relationship between the duration of obstructive respiratory events and outcomes of multilevel upper airway surgery in patients with obstructive sleep apnea

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