Long‐Term Results of Uvulopalatopharyngoplasty for Obstructive Sleep Apnea Syndrome

Objectives Assessment of the long‐term effect of uvulopalatopharyngoplasty (UPPP) on snoring, excessive daytime sleepiness, and nocturnal oxygen desaturation index (ODI) in patients with obstructive sleep apnea syndrome. Study Design Evaluation of snoring, excessive daytime sleepiness, and ODI in patients treated by UPPP earlier. Materials and Methods Patients (n = 58) with a follow‐up period of 11 to 74 months (median, 34 mo) were included in this study. Snoring and excessive daytime sleepiness were scored on specially designed semiquantitative scales. In all patients ODI was calculated from pulse‐oximetry combined with polysomnography at base line and by polygraphy (MESAM 4) during follow‐up in 38 patients. Long‐term response was compared with 6‐month response in the same cohort. Results There was a long‐term improvement of snoring in 63% of patients, no change in 23%, and a deterioration in 14% (P < .00001). Overall snoring increased slightly between 6 months and long‐term follow‐up. There was an improvement of excessive daytime sleepiness in 38%, no change in 27%, and a deterioration in 35% (P = .80). Excessive daytime sleepiness showed a relapse to preoperative levels between 6 months and long‐term follow‐up. The median improvement of ODI was ?1 (95% interpercentile range, 73–51) and was not significant (P = .35). In 5 of 13 patients in whom ODI at baseline exceeded 20, ODI was reduced to less than 20. In 4 of the 38 patients ODI was reduced to less than 5. The improvement of ODI decreased significantly between 6 months and long‐term follow‐up (P = .03). No relation was found between body mass index, Mueller maneuver, X‐cephalometry, and long‐term outcome. An additional finding was that the ODI decreased after UPPP in combination with tonsillectomy, compared with a slight increase after UPPP alone; the difference was significant (P = .008). Conclusion The response to UPPP for obstructive sleep apnea syndrome decreases progressively over the years after surgery. UPPP in combination with tonsillectomy was more effective than UPPP alone.     

UPPP for snoring: long-term results and patient satisfaction

We retrospectively survey 57 patients who underwent uvulopalatopharyngoplasty (UPPP) because of habitual snoring over a five-year period. A total of 100 patients were sent questionnaires concerning persistent snoring, excessive daytime sleepiness (EDS), body mass index (BMI) and postoperative complications. After 5 years the success rate was 53%. The mean snoring score was 16.7 preoperatively and decreased to 10.6 postoperatively. There was a relationship between the body mass index (BMI) preoperatively and the efficiency of the surgery. The mean EDS score was 11.1 before and 9.4 after surgery. UPPP in patients complaining of snoring is quite successful but the results decline significantly with time and patients should be warned of the possibility of snoring remaining or returning.     

Objective benefit of laser palatoplasty for non-apnoeic snoring.

Laser palatoplasty (LPP) is widely used for the treatment of non-apnoeic snoring, despite the lack of objective data supporting its use. We report measurements of snoring in a prospective study of LPP, and we compare the results with a previous study of uvulopalatopharyngoplasty (UPPP). Twenty patients with an apnoea/hypopnoea index < 20 h-1 underwent LPP for habitual snoring. Overnight sound recordings were compared before and 6 months after operation using three objective indices; L, (the level exceeded by the loudest 1% of sound), L5 (the level exceeded by the loudest 5% of sound) and P50 (% total sleep time above 50 dBA). The subjective impression of snoring severity (Wilcoxon test, P < 0.001), and objective indices L1 and P50 (t-test, P < 0.001) showed significant reductions after LPP. The mean change in L1 was 4.2 dBA, comparable to that we previously reported for UPPP, while P50 was reduced to less than one-third its preoperative value. No other sleep variables changed significantly following LPP. We conclude that LPP results in reduced snoring volume comparable to that following UPPP.     

Effect of Isolated Uvulopalatopharyngoplasty on Subjective Obstructive Sleep Apnea Symptoms

Objectives

The aims of this study were 1) to evaluate the effect of isolated uvulopalatopharyngoplasty (UPPP) on subjective obstructive sleep apnea (OSA) symptoms in adult patients regardless of the response to surgery, and ultimately 2) to investigate the differences in changes in subjective OSA symptoms between successful and unsuccessful surgery groups.

Methods

Twenty consecutive adult patients who underwent isolated UPPP were enrolled. Pre- and postoperative subjective OSA symptoms (snoring, witnessed apnea, daytime sleepiness, morning headache, daytime fatigue, restless sleep, difficulty with morning arousal) and polysomnographic data were evaluated in all subjects. Changes in subjective OSA symptoms before and after surgery were investigated in the successful (n=11) and unsuccessful (n=9) groups. Surgical success was defined as a reduction of at least 50% in the preoperative apnea-hypopnea index (AHI) and a postoperative AHI less than 20 per hour.

Results

After isolated UPPP, all subjective OSA symptoms changed significantly in the patients, especially in the successful group. In the unsuccessful group, snoring, witnessed apnea and daytime fatigue changed significantly, while other symptoms did not change significantly after surgery.

Conclusion

Isolated UPPP may improve subjective OSA symptoms in adult patients whom surgery was successful or unsuccessful. However, after isolated UPPP, the improvements in subjective OSA symptoms in the unsuccessful group may be different from those in the successful group.     

Breathing during sleep immediately after uvulopalatopharyngoplasty

Uvulopalatopharyngoplasty (UPPP) has been acclaimed in the treatment of obstructive sleep apnea (OSA). Evaluation of the effect of UPPP has usually been done 6 to 8 weeks postoperatively. Recently, a patient died suddenly at home of unknown causes 48 hours following UPPP. Autopsy evaluation demonstrated no evidence of hemorrhage, aspiration, or airway edema; however, it caused us to reassess our postoperative program. Three obese patients (192%, 162% and 157% of ideal body weight) with OSA underwent polysomnography on the second postoperative night. The mean duration of the postoperative apneas was not significantly different; however, the nadir SaO2 during apnea in one patient was significantly lower postoperatively. Those individuals with awake hypercapnia nad hypoxemia who had significant sleep associated hemoglobin unsaturation preoperatively may be at greatest risk. These observations indicate that careful postoperative monitoring is warranted in this group of patients.     

Postoperative evaluation of sleep apnea after uvulopalatopharyngoplasty

Uvulopalatopharyngoplasty (UPPP) is an operation that is frequently performed for the treatment of obstructive sleep apnea (OSA). While UPPP usually eliminates or decreases snoring and often reduces excessive daytime sleepiness, the decrease in the number of episodes of apnea and hypopnea, and the improvement in oxygen saturation (SaO2) have been less predictable. We compared preoperative and postoperative polysomnography (PSG) in 27 patients with OSA and found that no single PSG parameter could accurately reflect the changes in respiration seen after UPPP. We suggest that a combination of indices including the apnea index, the apnea and hypopnea index, the frequency and severity of decreases in SaO2, and the lowest SaO2 be used to assess the effect of UPPP. Using this combination we determined that 30% of our patients were markedly improved, 33% were somewhat improved, and 37% were unimproved. To rely solely on the patient's subjective improvement often results in overestimating the therapeutic results of surgery, whereas to rely only on one PSG parameter may underestimate or overestimate the degree of improvement.     

The relationship between the Epworth Sleepiness Scale and polysomnographic parameters in obstructive sleep apnea patients

The aim of this study was to investigate the relationship between the subjective Epworth Sleepiness Scale (ESS) and objective polysomnographic parameters that was compared in dichotomized groups of obstructive sleep apnea (OSA) patients with and without excessive daytime sleepiness (EDS). A retrospective review of the 96 consecutive snoring patients suspected of OSA due to upper airway problems was performed. ESS score was assessed and EDS was considered present when the ESS score was >10. Polysomnography was performed for each patient. Comparisons of polysomnographic parameters between both groups of patients were performed using Mann–Whitney U-tests. The Pearson’s correlation coefficient was calculated. EDS patients showed significantly greater body mass index (BMI), AHI and ODI, higher percentage of snoring time, a longer time length of SpO₂ < 90% and lower minimum SpO₂ compared to no EDS patients. There was no statistical difference in other sleep parameters. A positive correlation between the ESS score and BMI, percentage of snoring time, minimum SpO₂ and time length of SpO₂ < 90% was identified. Despite many controversies, our conclusion is that apnea/hypoxemia has considerable coherence to account for the EDS measured by ESS in OSA patients.     

Long-time follow-up after UPPP for obstructive sleep apnea syndrome. Results of sleep apnea recordings and subjective evaluation 6 months and 2 years after surgery

Fifty unselected consecutive patients with obstructive sleep apnea syndrome (OSAS) underwent uvulopalatopharyngoplasty (UPPP). The diagnosis was based on the patient's history and recording of respiration movements (Static Charge Sensitive Bed. SCSB) and oximetry, alone or combined with polysomnography. Renewed SCSB oximetry recordings were used to evaluate the success of the treatment. Six months postoperatively 40% of the patients were classified as non-responders, i.e. their oxygen desaturation indices (ODI) were reduced by less than 50% or were still above 20. The mean body mass index (BMI) was significantly higher in the non-responder group. A second recording with complete data was obtained in 45 patients after an average of 21 months. It was found that 9 patients who had been responders in the first postoperative recording had become non-responders. Only 18 of the patients with complete data could be verified as responders after 2 years. The patients who relapsed showed a significant increase in mean BMI between the first and second postoperative recordings compared to the patients who remained responders. There were no significant differences between responders and non-responders concerning age or preoperative severity of OSAS expressed as ODI, nadir SaO2 and percentage of obstructive periodic breathing. Of the non-responders, 47% in the first postoperative recording and 52% in the second reported complete recovery from excessive daytime sleepiness. This subjective improvement was not correlated to the objective results. The conclusions of this study are thus that one postoperative recording is not enough to estimate the outcome of UPPP and that statements of the patient's subjective recovery alone must not be used for this purpose.     

Radiofrequency tissue volume reduction of the soft palate and UPPP in the treatment of snoring

The purpose of this study was to evaluate the efficiency of radiofrequency tissue volume reduction (RFTVR) and uvulopalatopharyngoplasty (UPPP) in the treatment of snoring in a prospective clinical trial of 79 patients consecutively undergoing surgery for snoring. Seventy-nine patients with primary snoring or mild OSAS (obstructive sleep apnea syndrome) were enrolled in this clinical trial (66 males and 13 females). According to the anatomical findings (the size of the tonsils and uvula), the patients underwent UPPP/TE of the RFTVR of the soft palate. Forty-seven patients had UPPP/TE (age 45.81±12.11 years; median AHI: 8; range 1–29). Thirty-two patients were treated with RFTVR of the soft palate (age 48.10±10.92; median AHI: 5.0; range 0–26). The average number of treatments was 2.2. All patients underwent preoperative polysomnography to exclude severe OSAS. Pre- and postoperative snoring scores were evaluated from the patients with bed partners. Postoperative follow-up data were collected at a median of 4 months after treatment; 85.1% of the UPPP group and 53.1% of the RFTVR group underwent postoperative polysomnography. Subjective snoring scores of all study participants were evaluated. Preoperatively, there was no statistically significant difference of subjective symptoms, age and BMI between the two groups. The snoring scores improved statistically significantly in both groups ( P <0.001 in the UPPP group; P =0.001 in the RFTVR group). After UPPP/TE snoring improved in 37 patients (78.7%), and 29 (61.7%) thereof were free of bothersome snoring; no change was found in 9 patients (19.2%), and 1 (2.1%) worsened. In the RFTVR group, snoring improved in 15 (46.9%), and 9 (28.1%) thereof were free of bothersome snoring; no change was found in 13 patients (50%), and 1 worsened (3.1%). Preoperative AHI was statistically higher ( P =0.016) and mean minimal oxygen saturation significantly lower ( P =0.002) in the UPPP group. In the UPPP group AHI and HI showed statistically significant improvement postoperatively ( P =0.025 and P =0.034, respectively). After RFTVR, no statistically significant change of AHI, HI or oxygen saturation was found. Besides limited mucosal erosions (15%) after RFTVR and foreign body sensations (<10%) after UPPP/TE, no side effects were observed. The success rate of RFTVR of the soft palate is lower compared to the more invasive technique of UPPP. Due to its minimally invasive character, RFTVR is suitable as first-step treatment for snoring, but patients should be counseled about possible success rates and different treatment options.     

Site of airway collapse in obstructive sleep apnea after uvulopalatopharyngoplasty

The objective of this prospective study was to determine the site and pattern of upper airway collapse by a multiple-catheter technique in subjects demonstrated to have obstructive sleep apnea (OSA) after uvulopalatopharyngoplasty (UPPP). Standard diagnostic nocturnal polysomnography (PSG) was done on all subjects. The PSG recordings included electroencephalogram, electrooculogram, electrocardiogram, chin and leg electromyograms, nasal and oral airflow, and abdominal effort. Polysomnography with a multiport flexible airway Gaeltec catheter was performed in 22 subjects. The Gaeltec flexible airway catheter has 4 high-fidelity pressure sensors to aid in determining the primary site of airway collapse. The primary site of airway collapse was determined by differential pressure gradients between pressure ports and by visual inspection of the pressure tracings. Forty-two subjects with prior UPPP from a total of 60 (39 men and 3 women, ages 33 to 61) agreed to be to studied by the standard PSG technique. Thirty-five subjects complained of excessive daytime sleepiness. Ten had mild OSA, 10 had moderate OSA, 12 had severe OSA, and 10 were "normal." Of the 22 subjects who had airway catheter monitoring, 3 of the normals were reclassified as having upper airway resistance (mean peak negative esophageal pressure of -28 cm H2O); 2 patients demonstrated airway obstruction in the nasopharynx, 2 at the oropharynx, and 11 at the level of the hypopharynx. Postoperative nocturnal PSG data were compared to data gathered prior to UPPP. The mean respiratory disturbance index (RDI) for the catheter group was 54 events per hour prior to UPPP, and the mean RDI after surgery was 44. There was no correlation between the severity of OSA and the stage of sleep. We conclude that the majority of patients who complain of excessive daytime sleepiness following UPPP have OSA with the primary site of obstruction at the level of the hypopharynx. The severity of airway collapse is variable during each stage of sleep. Esophageal pressure monitoring during sleep should be considered when evaluating symptoms of persistent OSA in patients who have had UPPP.     

Results of uvulopalatopharyngoplasty after diagnostic workup with polysomnography and sleep endoscopy: a report of 136 snoring patients

We subjectively and objectively evaluated 136 patients with socially unacceptable snoring (SUS) or obstructive sleep apnoea syndrome (OSAS) treated with uvulopalatopharyngoplasty (UPPP) after a diagnostic workup by sleep registration (polysomnography, PSG) and sleep endoscopy. Of the 136 patients, there were 88 with OSAS and 48 with SUS. The results of the procedure were considered subjectively to be an improvement in 38 (79%) of the SUS patients and in 74 (84%) of the patients with OSAS. In 36 (40%) of the 88 patients with OSAS, repeating PSG postoperatively was considered unnecessary because of obvious improvement. Of the 52 patients with a measurement after UPPP, a decrease in the apnoea hypopnoea index (AHI) was found in 38 (73%; median decrease: 48%), and AHI dropped below 20 in 32 (62%). The apnoea index (AI) was available in 49 (56%) patients and was reduced in 31 (63%; median decrease: 73%). An overall positive result in the 88 patients with OSAS (combining available data on subjective and objective results) was therefore found in 61 (69%; positive subjective result and AHI <15) or 71 (81%; positive subjective result and decrease in AHI), respectively, depending on the definition. We conclude that after diagnostic workup by sleep registration and sleep endoscopy, the success rate of UPPP increases as compared to historical controls.     

Objective benefit of laser palatoplasty for non-apnoeic snoring

Laser palatoplasty (LPP) is widely used for the treatment of non-apnoeic snoring, despite the lack of objective data supporting its use. We report measurements of snoring in a prospective study of LPP, and we compare the results with a previous study of uvulopalatopharyngoplasty (UPPP). Twenty patients with an apnoea/hypopnoea index <20 h^{? 1} underwent LPP for habitual snoring. Overnight sound recordings were compared before and 6 months after operation using three objective indices; L₁ (the level exceeded by the loudest 1% of sound), L₅ (the level exceeded by the loudest 5% of sound) and P₅₀ (% total sleep time above 50 dBA). The subjective impression of snoring severity (Wilcoxon test, P < 0.001), and objective indices L₁ and P₅₀ (t-test, P < 0.001) showed significant reductions after LPP. The mean change in L₁ was 4.2 dBA, comparable to that we previously reported for UPPP, while P₅₀ was reduced to less than one-third its preoperative value. No other sleep variables changed significantly following LPP. We conclude that LPP results in reduced snoring volume comparable to that following UPPP.     

Laser assisted uvulopalatoplasty (LAUP) in the treatment of snoring and obstructive sleep apnea syndrome

Laser Assisted Uvulopalatoplasty (LAUP) the surgical technique for the treatment of snoring and obstructive sleep apnea syndrome was first performed by Kamami in 1988. LAUP can reduce the airway obstruction in the oropharynx level. LAUP is the simple, reliable surgical procedure performed in an office setting under the local anesthesia, without hospitalization. From 1998 to 2000 37 patients underwent LAUP in our ENT Department in Zabrze. This group comprised of 19 OSA patients and 18 habitual snorers. In cases of nasal obstruction by turbinate hypertrophy or septal deviation we performed septoplasty or partial inferior turbinectomy by laser CO2. In some cases with palatin or lingual tonsils hypertrophy we also performed tonsillectomy or lingual tonsil laser ablation. In 5 patients LAUP was performed in several stages. Before and after the surgical treatment each patient were evaluated by PolyMESAM--the device belongs to the third diagnostic level. In all postoperative evaluated OSA patients the RDI decreased significantly. In 4 patients (50% of evaluated after LAUP patients) the RDI dropped to 10 or lower. Snoring was eliminated or significantly reduced in 83% of patients classified as the habitual snorers. No serious complications were observed. LAUP is a good alternative to UPPP in the surgical treatment of habitual snorers and some of the patients with OSA syndrome.     

Previous tonsillectomy as prognostic indicator for success of uvulopalatopharyngoplasty

Factors that determine a successful outcome following uvulopalatopharyngoplasty (UPPP) for obstructive sleep apnea (OSA) are not well defined. This study was undertaken to determine if prior tonsillectomy is predictive of a lower response rate to UPPP. A retrospective review of a cohort undergoing UPPP alone or in combination with nasal septoplasty for OSA was undertaken. Preoperative and postoperative polysomnograms were obtained to evaluate the severity of the OSA. The sample was a consecutive series of 79 patients with OSA. Clinical evaluation was performed by both an otolaryngologist and a pulmo-nologist. Surgical treatment in this group of 79 patients included 52 UPPP and 27 UPPP in patients with prior tonsillectomy. Concurrent septoplasty was undertaken in 17 patients. Criteria for outcome were based on comparison of preoperative and postoperative polysomnograms (i.e., apnea index, respiratory disturbance index change, and lowest saturation). A response to therapy was defined as a reduction in apnea index greater than 50%. A success was defined as apnea index less than 5, reduction of respiratory disturbance index greater than 50%, and nadir saturation greater than 82%. In 79 patients with OSA, 78% responded and 37% reflected therapeutic successes. Patients with history of prior tonsillectomy were less likely to have therapeutic improvement following UPPP. In 52 patients without previous tonsillectomy, 88% responded and 52% had a successful outcome. of those with previous tonsillectomy, 59% responded and 7% had a successful outcome. The status of previous tonsillectomy is an important prognostic indicator in the success of UPPP for the treatment of OSA. We speculate that the presence of palatine tonsils allows the removal of an extra measure of oropharyngeal tissue, thereby improving the likelihood of success for UPPP.     

上气道测压在悬雍垂腭咽成形术后失败患者阻塞定位的应用

目的 应用上气道压力测定法判断悬雍垂腭咽成形术（uvulopalatopharyngoplsaty,UPPP）后失败患者气道阻塞部位。方法 对10例UPPP术后仍有打鼾或白天嗜睡的患者同期行整夜睡眠监测和上气道压力测定,判断其呼吸紊乱程度和气道阻塞部位,分析体位对呼吸紊乱低通气指数(apnea hypopnea index,AHI)的影响。结果 3例为中度,7例为重度阻塞性 呼吸暂停。上气道阻塞部位可分上部（主要为腭后区）和下部（主要为舌后区）,10例均为上部和下部联合阻塞,其中6例以上部,4例以下部阻塞为主。仰卧位呼吸暂停AHI（66.52±22.51）次/h,侧卧位AHI（47.82±21.82）次/h,差异有统计学意义（P=0.017）。结论 上气道压力测定法可较好地判断阻塞性睡眠呼吸暂停低通气综合征患者的气道阻塞部位,多数UPPP术后患者以腭后区阻塞为主,且仰卧位较侧卧位更易引起气道塌陷。     

Clinical and functional analysis of long-term results of uvulopalatopharyngoplasty

In order to evaluate the clinical and functional effectiveness of uvulopalatopharyngoplasty (UPPP) in chronic roncopathy, we studied the subjective improvement of operated patients and compared to pulsioximetry findings before and after surgery. A follow-up was made on 72 patients entitled of chronic roncopathy--51 with obstructive sleep apnea syndrome (OSAS) and 21 with simple snoring-, for a mean period of time of 41 months. Preoperatory study included on ENT exploration, fibre optic endoscopy, Müller maneuver, pharyngeal CT, value of daytime sleepiness with Epworth's scale, espirometry and pulsioximetry, and the postoperatory study included of pulsioximetry and a health questionnaire over snoring and daytime sleepiness. Snoring improved or disappeared in 13 of 21 patients (61.8%), and daytime sleepiness did it in 26 of 39 (66.6%). Therapeutic failure in snoring was mainly due to an increase in the body mass index. After UPPP in OSAS, only 21 patients (41.1%) showed all positive response criteria (decrease into ODI > or = 50% or in absolute values < 6, CT 90% < 1%, and SaO2 Min > or = 85%). UPPP failed in long term evaluation in the rest of individuals. Patient selection is mandatory to optimize clinical response of UPPP for snoring, without OSAS success depends on body mass index, respiratory disturbances ratios and the eventual presence of another upper airways collapses below velopharyngeal segment.     

Adenotonsillectomy for obstructive sleep apnea in children: outcome evaluated by pre- and postoperative polysomnography

OBJECTIVE: To evaluate the outcome of adenotonsillectomy for obstructive sleep apnea (OSA) in children using objective data from polysomnography supplemented by subjective proxy reports from the OSA-18 quality of life instrument. STUDY DESIGN: Prospective cohort study. METHODS: Children 3 to 14 years of age with OSA diagnosed principally on the basis of polysomnography as having an obstructive apnea/hypopnea index (AHI) of 5 or greater underwent adenotonsillectomy. OSA was classified as mild (AHI > or = 5 < 10), moderate (AHI > or = 10 < 20), or severe (AHI > or =20). Children enrolled in the study also had postoperative polysomnography 3 to 6 months after surgery. Caregivers completed the OSA-18 survey before surgery and within 6 months after surgery. Pearson correlation was used to compare the pre- and postoperative AHI values with the pre- and postoperative OSA-18 total scores. SAS procedures (SAS Corp., Cary, NC) were used for statistical analyses. A P value less than or equal to .05 was considered significant. RESULTS: The study population included 79 healthy children, 40 of who were male. The mean age was 6.3 (range, 3.0-14.0) years. Only tonsillar size was correlated significantly with a high preoperative AHI. For all children, the preoperative AHI value was higher than the postoperative value. The mean preoperative AHI for the study population was 27.5, whereas the mean postoperative AHI was 3.5. This change was highly significant (P < .001). The percentage of children with normal polysomnography parameters after adenotonsillectomy ranged from 71% to 90% as a function of the criteria used to define OSA. It was highest when an obstructive apnea index less than 1 was used and lowest when an AHI less than 1 was used to define resolution of OSA. Overnight respiratory parameters after adenotonsillectomy were normal for all children with mild OSA. Three (12%) children with moderate preoperative OSA, and 13 (36%) children with severe preoperative OSA had persistent OSA after adenotonsillectomy. Resolution of OSA occurred in all children with a preoperative AHI less than or equal to 10 and in 73% of children with a preoperative AHI greater than 10. The mean total OSA-18 score and the mean scores for all domains showed significant improvement after surgery (P < .001). The preoperative AHI values had a fair correlation with the preoperative total OSA-18 scores (r = 0.28), but postoperative AHI values had a poor correlation with the postoperative total OSA-18 scores (r = 0.16). Caregivers reported snoring some, most, or all of the time in 22 (28%) children; this group included all children with persistent OSA. CONCLUSIONS: Adenotonsillectomy for OSA results in a dramatic improvement in respiratory parameters as measured by polysomnography in the majority of healthy children. Quality of life also improves significantly after adenotonsillectomy for OSA in children. However, the correlation between improvements in respiratory parameters and improvements in quality of life is poor. Severe preoperative OSA is associated with persistence of OSA after adenotonsillectomy. Postoperative reports of symptoms such as snoring and witnessed apneas correlate well with persistence of OSA after adenotonsillectomy.     

便携式睡眠监测仪应用于儿童OSAHS诊断的临床分析

摘要：目的初步探讨便携式睡眠监测仪（PM）在儿童阻塞性睡眠呼吸暂停低通气综合征（OSAHS）中的临床诊断价值。方法随机选择门诊收治的以经常性睡眠打鼾为主诉的儿童患者36例，其中男23例，女13例；年龄4~13岁，平均年龄（7.0±2.6）岁，应用PM与多导睡眠监测仪（PSG）对患儿进行整夜同步睡眠呼吸监测，同时完成儿童OSAHS疾病特异性生活质量调查表（OSA 18），分析PM灵敏度及特异性，对比分析两种睡眠监测仪临床各参数的相关性，以及OSA 18问卷与AHI相关性。结果以PSG监测结果为标准，在儿童OSAHS 监测诊断中，根据严重程度分为单纯鼾症2例，轻度5例，中度12例，重度17例；PM分析单纯鼾症1例，轻度6例，中度10例，重度19例，PM的灵敏度为97.1%，特异度为100.0%，准确率为97.2%；两种睡眠监测仪的睡眠呼吸暂停低通气指数（AHI）、最低血氧饱和度（LSaO2）及平均血氧饱和度（MSaO2）有相关性，OSA 18问卷与PM及PSG监测的AHI呈正相关性（r=0.875、0.874，P均<0.05）。结论PM辅以OSA 18问卷调查在儿童OSAHS中具有较高的临床诊断价值，且PM与PSG各项指标相关性良好，操作简便，值得临床推广应用。     

Auditory brainstem response in obstructive sleep apnea

Auditory brainstem response (ABR) has been used by several investigators to study the role of the brain stem in the pathophysiology of obstructive sleep apnea (OSA). These studies have produced conflicting results. We studied 27 preoperative OSA patients and 17 controls using click stimuli presented at a slow (11.7/second) rate and at a fast (57.7/second) rate. ABR was repeated postoperatively in 18 patients. There were no statistically significant differences in the ABRs of preoperative OSA patients when compared with the control group. However, the preoperative recordings showed statistically significant prolonged latencies for wave III (p less than 0.01) and interpeak latency (IPL) I-III (p less than 0.01) when compared to postoperative recordings. Rapid-rate testing was not helpful. Although normal sleep does not cause ABR abnormalities, the pathological sleepiness seen in OSA patients may cause brainstem dysfunction manifested by prolonged ABR latencies. These abnormalities may resolve with treatment of OSA.     

Efficacy of endoscopic static pressure/area assessment of the passive pharynx in predicting uvulopalatopharyngoplasty outcomes.

OBJECTIVES/HYPOTHESIS: Although uvulopalatopharyngoplasty (UPPP) is an attractive surgical treatment for obstructive sleep apnea (OSA), the unpredictable outcome limits application of the procedure. Since UPPP corrects only retropalatal airway (RP) patency, we hypothesized that response to UPPP is determined by collapsibility of the retroglossal airway (RG), where UPPP does not correct. METHODS: We estimated closing pressure (Pclose) for each pharyngeal segment by endoscopically obtaining the static pressure/area relationship of the passive pharynx in completely paralyzed and anesthetized patients with sleep-disordered breathing (n = 41) before UPPP. Preferable response to UPPP was defined as the number of oxygen dips (ODI), obtained by nocturnal oximetry, less than 10 h(-1) after UPPP. RESULTS: Patients with negative Pclose at RG responded to UPPP significantly better than those with positive Pclose at RG (22/30 [73%] vs. 3/11 [27%], P<.05). ODI after UPPP was significantly correlated with age, Pclose at RP, and Pclose at RG. CONCLUSIONS: Endoscopic assessment of anatomic abnormality of the pharynx in paralyzed patients with sleep-disordered breathing under general anesthesia has clinical value for the improvement of UPPP outcome.