The influence of multilevel upper airway surgery on CPAP tolerance in non-responders to obstructive sleep apnea surgery

Azbay, Sule; Bostancı, Aslı; Aysun, Yasin; Turhan, Murat

doi:10.1007/s00405-015-3865-5

Cited by 16 publications

(19 citation statements)

References 16 publications

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“…A meta-analysis of 1978 patients showed that the overall success rate was 66.4% in patients with multilevel sleep apnea surgery involving at least two anatomical sites: nose, oropharynx, or hypopharynx [ 13 ]. Furthermore, patients receiving postoperative CPAP had lower AHI and ESS scores and higher SpO 2 [ 14 ]. Azbay et al reported that approximately 48% of patients who cannot tolerate CPAP preoperatively can tolerate it postoperatively [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

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Combined Surgical Approach for Obstructive Sleep Apnea Patient

Ebrahim

Alsanea

Alterki

2018

Case Reports in Otolaryngology

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Obstructive sleep apnea (OSA) is a disease that is associated with high morbidity and mortality and can significantly impact the quality of life in a patient. OSA is strongly associated with obesity, and literature showed that weight loss will lead to improvement in OSA. The gold standard treatment for OSA is continuous positive airway pressure (CPAP). However, other methods of treatment are available. One of these methods is multilevel sleep surgery (MLS). Literature showed that bariatric surgery can also improve OSA. A common question is which surgical procedure of these two should be performed first. We present a 5-year follow-up of a patient who underwent simultaneously bariatric surgery and MLS. His apnea-hypopnea index (AHI) decreased from 53 episodes per hour to 5.2 per hour within the first 18 months, which was measured via a level 3 polysomnography. Five years after the surgery, a repeat level 3 polysomnography showed an AHI of 6.8 episodes per hour, and the patient is asymptomatic. The patient maintained his weight and did not use CPAP after the combined surgery during the five-year period.

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Section: Discussionmentioning

confidence: 99%

“…Furthermore, patients receiving postoperative CPAP had lower AHI and ESS scores and higher SpO 2 [ 14 ]. Azbay et al reported that approximately 48% of patients who cannot tolerate CPAP preoperatively can tolerate it postoperatively [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Combined Surgical Approach for Obstructive Sleep Apnea Patient

Ebrahim

Alsanea

Alterki

2018

Case Reports in Otolaryngology

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“…CPAP and surgery are not exclusive from each other; actually, they can have mutual benefits and reciprocity. For example, nasal, tongue base and multiple-level surgery can reduce CPAP pressure and improve CPAP compliance in OSA [22] , [23] , [24] . By contrast, CPAP can be used to stabilize airway after intrapharyngeal surgery especially in tongue surgery [25] .…”

Section: Principle In Decision-making Between Cpap and Surgerymentioning

confidence: 99%

Intrapharyngeal surgery with integrated treatment for obstructive sleep apnea

Lee

Hsin

et al. 2019

Biomedical Journal

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Obstructive sleep apnea (OSA) is a common disease in adults, which influences human relations, quality of life and associates with major complications. Continuous positive airway pressure (CPAP) is the gold standard treatment modality in OSA patients. For patients incompliant or unwilling to CPAP therapy, surgery is an alternative treatment. Sleep surgery for OSA include intrapharyngeal surgery, extrapharyngeal surgery and bariatric surgery addressing upper airway soft tissue, maxillofacial bone, and obesity, respectively. Among sleep surgeries, intrapharyngeal surgery (soft tissue surgery) is widespread used and serves overwhelming majority in OSA surgical patients. Despite the popularity of intrapharyngeal surgery, its outcomes can be influenced by multiple factors and consequently need conjunctive remedy to enhance at the short-term and sustain in the long-term. In this article, we introduce updated indications for treating OSA, practical principle in decision-making between CPAP and surgery, hybrid procedures in treating obstruction at the nose, palate, tongue and epiglottis, and postoperative integrated treatment including oropharyngeal myofunctional therapy (local), positional therapy (regional), and body weight reduction (systemic), and circadian rhythm (central). In summary, intrapharyngeal surgery is a target-oriented procedure that needs to be performed precisely and combines with integrated treatment as a holistic care for OSA patients.

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“…Post-operatively, about 50% of the study sample reported that their symptoms were resolved, and about 50% tolerated CPAP without problems. On the other hand, Hui, et al investigated the therapeutic effects of a MAD combined with either nasal or pharyngeal surgery [6]. The AHI of the combined surgical group was significantly lower post-operatively, and the authors concluded that surgical enlargement of the nasal and pharyngeal airways combined with a MAD is an effective treatment in patients with severe OSA.…”

Section: Introductionmentioning

confidence: 99%

Biomimetic Oral Appliance Therapy in Adults with Mild to Moderate Obstructive Sleep Apnea Using Combined Maxillo-Mandibular Correction

Singh¹

2017

J Sleep Disord Manag

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Introduction: Although mandibular advancement devices (MADs) are utilized for the management of mild to moderate OSA, there are concerns about temporo-mandibular joint (TMJ) issues. Biomimetic oral appliance therapy (BOAT) differs from MADs as it aims to achieve midfacial redevelopment in combination with mandibular repositioning. In this study, we tested the hypothesis that mild to moderate cases of OSA can be addressed with combined maxillo-mandibular correction using BOAT.Methods: Nineteen adults diagnosed with mild to moderate OSA, following an overnight home sleep test (HST) that had been interpreted by a physician, participated in this study. Each subject was treated by a dentist with advanced training in dental sleep medicine. At each monthly followup, the devices were adjusted to optimize their efficacy. The mean apnea-hypopnea index (AHI), respiratory disturbance index (RDI) and oxygen desaturation index (ODI) of the study sample was calculated prior to and after BOAT. The findings were subjected to statistical tests. Results:Prior to treatment the mean AHI of the study subjects was 12.8 hr -1 ± 5; the mean RDI was 18.6 hr -1 ± 8.2, and the ODI was 6.3% ± 3.5. Follow-up HSTs after approximately 9 mos. indicated the mean AHI decreased significantly to 6.2 hr -1 ± 2.9 after BOAT (p < 0.001), which represents a fall in the mean AHI by 51.5% for the study sample. The mean RDI fell to 12.3 hr -1 ± 6.9 (p < 0.001), and the ODI was improved to 2.6% ± 1.7 (p < 0.001). Conclusions:This study suggests that combined maxillomandibular correction may be a useful method of managing mild to moderate cases of OSA in adults, and represents an alternative to MADs and continuous positive airway pressure therapy. However, further studies are needed to determine the additional advantages of combined maxillomandibular correction.

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The influence of multilevel upper airway surgery on CPAP tolerance in non-responders to obstructive sleep apnea surgery

Cited by 16 publications

References 16 publications

Combined Surgical Approach for Obstructive Sleep Apnea Patient

Combined Surgical Approach for Obstructive Sleep Apnea Patient

Intrapharyngeal surgery with integrated treatment for obstructive sleep apnea

Biomimetic Oral Appliance Therapy in Adults with Mild to Moderate Obstructive Sleep Apnea Using Combined Maxillo-Mandibular Correction

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