Tongue base suspension combined with UPPP in severe OSA patients.

OBJECTIVE: Tongue base surgery in the severe OSA patients may improve the success of uvulopalatopharyngoplasty (UPPP) as the collapse is multilevel. The aim of this study was to evaluate the long-term objective and subjective effectiveness of the minimally invasive tongue base suspension combined with UPPP in severe OSA patients. STUDY DESIGN AND SETTING: We conducted a retrospective analysis of 22 OSA patients undergoing UPPP and the tongue base suspension for the treatment of severe OSA. RESULTS: Twenty-two men who had their preoperative and postoperative polysomnography had a 54% reduction in the preoperative Respiratory Disturbance Index (RDI), from 47.50 +/- 15.74 to a level of 17.31 +/- 14.17. The standard surgical cure rate which is a >50% reduction in the RDI and a postoperative RDI of <20 events/hour was 81.81%. All patients had some degree of subjective improvement in their snoring, daytime sleepiness, and the Epworth sleepiness scale. CONCLUSIONS: The tongue base suspension combined with UPPP has been shown to reduce RDI better than UPPP alone. This minimally invasive technique is highly successful at 81.81% when combined with UPPP in the severe OSA patients with multilevel airway collapse. SIGNIFICANCE: This study shows the benefits of minimally invasive tongue base suspension combined with UPPP in severe obstructive sleep apnea syndrome.     

The role of the Genial Bone Advancement Trephine system in conjunction with uvulopalatopharyngoplasty in the multilevel management of obstructive sleep apnea.

OBJECTIVES: The successful surgical management of obstructive sleep apnea (OSA) requires surgical procedures that address both retropalatal and retrolingual airway obstruction. The Genial Bone Advancement Trephine (GBAT) system is a new, 1-step system that allows for isolation and advancement of the genioglossus muscle via a guided trephine system. The purpose of this project was to describe our experience using the GBAT system to perform genioglossus advancement (GGA) in conjunction with uvulopalatopharyngoplasty (UPPP) in the surgical management of OSA. STUDY DESIGN: Retrospective analysis of 35 consecutive patients undergoing GGA using the GBAT system in conjunction with UPPP for the management of OSA during a 3-year period (1999 to 2002). RESULTS: Twenty-four patients had complete preoperative and postoperative polysomnographic data. A 70% reduction in the Respiratory Disturbance Index (RDI) and Apnea Index (AI) in the preoperative versus postoperative PSG (RDI, 52.9 +/- 17.1 versus 15.9 +/- 7.5; AI, 20.1 +/- 6.7 versus 6.1 +/- 4.5; P < or = 0.0001). The lowest oxygen desaturation increased from 80% to 88% (P = 0.0002), and the posterior airway increased from 7.9 to 12.6 mm (P < 0.0001). With a surgical cure defined as a greater than 50% reduction in the RDI and a final postoperative RDI of less than 20 events per hour, the true surgical cure rate was 67% (16 of 24 patients). CONCLUSIONS: The GBAT system performed in conjunction with UPPP can produce significant reductions in RDI and AI while improving the oxygen desaturation and enlarging the posterior airway space. The effective cure rates using the GBAT system are in agreement with previous reports in the literature using various GGA techniques. The GBAT may have some advantages in terms of simplicity and safety.     

Role of the tongue base suspension suture with The Repose System bone screw in the multilevel surgical management of obstructive sleep apnea.

OBJECTIVE: The Repose System (tongue base suspension) is a new, minimally invasive technique for tongue base suspension in the treatment of obstructive sleep apnea. The purpose of this project was to describe our preliminary experience using this tongue base suspension system in conjunction with uvulopalatopharyngoplasty (UPPP) in the multilevel surgical approach to the management of obstructive sleep apnea (OSA). STUDY DESIGN: We conducted a retrospective analysis of 19 consecutive patients undergoing UPPP and The Repose System tongue base suspension for the management of obstructive sleep apnea during a 1-year period (1998 through 1999). RESULTS: Fifteen patients (11 men and 4 women) had complete preoperative and postoperative polysomnographic data. A 46% reduction in the preoperative respiratory disturbance index (RDI) (38.7 +/- 12.3) versus the postoperative RDI (21.0 +/- 7.4, P < 0.05) was demonstrated at a mean of 3.8 months after surgery. The apnea index demonstrated a 39% reduction. The surgical cure rate was 20% (3 of 15 patients). CONCLUSIONS: The Repose System in conjunction with UPPP has been shown to produce significant reductions in the RDI and apnea index as well as a significant increase in O2 saturation. Despite the improvement in these objective parameters, the overall surgical cure rate was only 20% (3 of 15 patients) in this retrospective series. Further research is warranted to define the role of The Repose System in the management of obstructive sleep apnea patients with multilevel airway obstruction.     

Genioglossus advancement and hyoid myotomy under local anesthesia.

OBJECTIVE: Obstructive sleep apnea syndrome (OSAS) is a common chronic illness that results in significant morbidity in many patients. Upper airway obstruction of OSAS patients occurring during sleep can appear at multiple sites, including the hypopharynx. Successful results of genioglossus advancement and hyoid myotomy with suspension (GAHM) in the treatment of hypopharyngeal obstruction have been reported when performed under general anesthesia. However, many patients have difficulty at induction of anesthesia and intubation. Patients are predisposed to specific complications, owing to anatomical abnormalities of the airway and existence of underlying syndrome. The purpose of this study was to assess the safety and efficacy of GAHM for the treatment of OSAS with the patient under local anesthesia. METHODS: Thirty-one OSAS patients with hypopharyngeal obstruction underwent GAHM under local anesthesia. The inferior alveolar nerve was blocked. The osteotomized mandibular segment was advanced and turned to lock the inner surface of the mandible and geniotubercle at the outer surface. The hyoid bone was suspended to the superior aspect of the thyroid cartilage. Uvulopalatal flap was an adjunct surgical procedure for palatal obstruction. Patients had a mean age of 46.2 +/- 5.8 years and a body mass index of 28.8 +/- 3.2 kg/m(2). Most of the patients were male. Data on patients were compared between preoperative and postoperative assessment points. Statistical analysis was performed using Student's t test. RESULTS: All patients tolerated the procedure well. The mean follow-up was 8 months (range, 6 to 10 months). The mean Respiratory Disturbance Index (RDI) decreased from 48.2 +/- 10.8 to 14.5 +/- 5.8, and the lowest oxygen saturation increased from 81.8 +/- 3.8% to 88.8 +/- 2.9%. The Epworth Sleepiness Scale score improved from 14.9 +/- 2.3 to 8.2 +/- 1.7 (P < 0.001), and the snoring scale improved from 8.1 +/- 0.6 to 3.4 +/- 0.9 (P < 0.001). Postoperative complications included wound dehiscence in 3%, transient dysphagia in 3%, and transient paresthesia of the lower jaw in 6%. Bleeding, infection, and airway obstruction were not observed. Most patients had mild-to-moderate pain (visual analog scale, /=50% and an RDI of 相似文献   

Assessment of the airway in obstructive sleep apnea syndrome with 3-dimensional airway computed tomography.

OBJECTIVE: The goal was to evaluate 3-dimensional airway CT for upper airway assessment in obstructive sleep apnea syndrome (OSAS). DESIGN: Airway CT was obtained and 3-dimensional airway models were constructed prospectively for 40 patients with OSAS and 10 controls. Airway dimensions were correlated with polysomnography, and comparison was made between patients with and without OSAS. RESULTS: OSAS patients had a mean respiratory distress index of 51.9 events per hour. The mean minimum cross-sectional area (XSA) in the neutral position was 67.1 mm(2). Minimum XSA decreased in both the inspiratory and expiratory phases to 16.3 mm(2) and 15.0 mm(2), respectively (P<0.001). Complete airway obstruction occurred in 1 or more phases of respiration in 28 patients. Neither airway XSA nor length of obstruction correlated with sleep apnea parameters. No statistically significant differences in airway dimensions were found between OSAS and control patients. CONCLUSIONS: Airway CT demonstrates dynamic airway obstruction in OSAS but does not correlate well with clinically important disease parameters.     

Transpalatal advancement pharyngoplasty outcomes compared with uvulopalatopharygoplasty.

OBJECTIVE: Uvulopalatopharyngoplasty (UPPP) success rates in patients classified with Friedman stage 3 is reported as 8%. Surgical failure may result from persistent obstruction at the palate, which may be addressed by pharyngoplasty with palatal advancement (PA). The effectiveness of PA versus UPPP was evaluated by using polysomnographic outcomes in a retrospective cohort of patients classified with Friedman stage 3. METHODS: Surgical records were reviewed for PA (n = 47) and UPPP (n = 124). Clinical records were reviewed and reclassified by Friedman stage. Respiratory data were collected from overnight polysomnography. Statistical analysis was conducted of continuous variables (ANOVA), categorical variables (chi2), and adjusted odds ratios by using logistic regression. RESULTS: PA (n = 30) and UPPP (n = 44) did not differ in baseline apnea hypopnea index (AHI), age, or BMI. Both PA (48.3 +/- 24.6 to 19.8 +/- 16.8 events per hour, P < 0.000) and UPPP (47.9 +/- 30.0 to 30.9 +/- 24.2 events per hour, P < 0.000) improved with surgery. In the PA group, final AHI was lower (17.1 +/- 30.1 versus 28.5 +/- 25.6, P < 0.04) and postoperative change was greater (30.9 +/- 24.2 versus 19.8 +/- 16.8, P < 0.02). For patients with Friedman stage 3, odds ratio of having an AHI of <20 events per hour and a greater than 50% reduction with PA compared with UPPP was 3.80 (95% CI, 1.41-10.29, P < 0.013). Adjusted for age, body mass index, preoperative apnea severity, and tongue-base surgery, OR was 5.77 (95% CI of 1.80-17.98). CONCLUSIONS: Polysomnographic outcomes using AHI support the use of palatopharyngoplasty using palatal advancement as an effective treatment of obstructive sleep apnea. PA may offer benefit over UPPP alone in patients classified with Friedman stage 3.     

Preoperative predictors of difficult intubation in patients with obstructive sleep apnea syndrome

PURPOSE: It has been speculated that the severity of obstructive sleep apnea syndrome (OSAS) is related to difficult intubation. However, this has not been confirmed in OSAS patients. Thus, we undertook a retrospective study to assess this relationship in patients who had undergone uvulopalatopharyngoplasty (UPPP) surgery for OSAS. METHODS: A retrospective case-control study was undertaken following approval from the Institutional Review Board on human studies. The data from 90 patients with a polysomnograph-confirmed diagnosis of OSAS, who had undergone UPPP surgery under general anesthesia, were used to evaluate the apnea-hypopnea index (AHI), the preoperative lowest arterial saturation, the occurrence of difficult intubation as assessed by the operator intubation difficulty scale score, extubation time, lowest arterial saturation in postanesthesia care unit, and length of stay in postanesthesia care unit. We compared OSAS patients with 90 age and sex-matched control patients with respect to the prevalence of difficult intubation. RESULTS: The prevalence of difficult intubation was higher in the OSAS group than in the control group (16.7% vs 3.3%, P = 0.003). When evaluating the OSAS group according to the occurrence of difficult intubation, AHI was significantly higher in the difficult intubation subgroup (67.4 +/- 22.5 vs 49.9 +/- 28.0, P = 0.026), and patients with an AHI >or= 40 showed a significantly higher prevalence of difficult intubation. CONCLUSION: This study shows that the occurrence of difficult intubation can be predicted using AHI in patients who undergo UPPP surgery for OSAS.     

Further evaluation of uvulopalatopharyngoplasty in the treatment of obstructive sleep apnea syndrome

Since its introduction in 1981 uvulopalatopharyngoplasty (UPPP) has become an alternative surgical approach to permanent tracheostomy in treating obstructive sleep apnea (OSA). However, the criteria for selecting candidates for this procedure are unclear and the prediction of a positive response remains an enigma. This article presents the experience with UPPPs performed on 35 patients who had moderate to severe OSA. Criteria for patient selection included apnea severity, cardiopulmonary sequelae, and clinical symptomatology. All but two patients demonstrated clinical improvement, although there was considerable variability in the degree of response. Patients were classified as good or poor responders on the basis of the severity index (SI), which represents the number of apneas and hypopneas per hour of sleep resulting in oxygen saturation below 85%. A greater than 50% improvement in the SI was considered a good response. Twenty-three patients (65.7%) were good responders and the remaining 12 (34.3%) were poor responders. The need for permanent tracheostomy was obviated in 16 of 32 patients presenting with disabling daytime sleepiness or severe cardiopulmonary sequelae. Therefore it appears that UPPP is useful for treating most OSA patients.     

One-phase management of severe obstructive sleep apnea: Tongue base reduction with hyoepiglottoplasty plus uvulopalatopharyngoplasty

OBJECTIVES: To describe the results of a 1 phase surgical procedure for the treatment of severe obstructive sleep apnea (OSA) attributable to tongue base obstruction. STUDY DESIGN AND SETTING: A retrospective nonrandomized study at S Orsola Malpighi University Hospital of Bologna, Italy. METHODS: Ten male patients affected by severe OSA (mean apnea/hypopnea index [AHI] of 54.7), underwent uvulopalatopharyngoplasty (UPPP) associated with tongue base reduction and hyoepiglottoplasty (TBRHE). The indications to this surgical procedure were based on the presence of hyolingual abnormalities and absence of craniofacial deficiencies determined by preoperative assessment. RESULTS: Mean AHI decreased from 54.7+/-11.5 to 9.4+/-5.4 whereas the mean low SaO2 value went from 77%+/-6.2 to 90.7%+/-3 and the time of sleep with SaO2<90% improved from 53%+/-17.2 to 7.3%+/-8. The overall success rate was 100%. CONCLUSIONS AND SIGNIFICANCE: TBRHE is an effective and safe treatment in patients with severe OSA attributable to tongue base obstruction and in absence of craniofacial deficiencies.     

小下颌畸形梗阻性睡眠呼吸暂停综合征的整复治疗

我们采用下颌骨颏部截骨前移加植骨术治疗15例小下颌畸形所致的梗阻性睡眠呼吸暂停综合征(Obstructive sleep apnea syndrome 下简称 OSAS)。通过前移下颌骨颏部及附着于截骨块上的颏舌肌,以扩大口腔容积和舌根部的呼吸道,消除了上呼吸道阻塞,治愈了 OSAS 并改善了患者的容貌。     

Predictors of erectile function improvement in obstructive sleep apnea patients with long-term CPAP treatment

The long-term effect of treatment with continuous positive airway pressure (CPAP) on erectile function was assessed in 60 patients with obstructive sleep apnea syndrome (OSAS). Severity of OSAS was evaluated by respiratory disturbance index (RDI) and minimal oxygen saturation (OxiMin). Severity of erectile dysfunction (ED) was assessed with the five question International Index of Erectile Function (IIEF-5) before and after CPAP treatment. Subjects were categorized into three groups on the basis of the change in IIEF-5 score: Group 1, no change (n=37); Group 2, improvement from 10+/-5.65 to 19.1+/-5.7, P<0.01 (n=12); Group 3, worsening from 19.9+/-4.7 to 9.5+/-7.8, P<0.01 (n=11). Group 2 had significantly higher RDI and lower OxiMin than the other groups, and was also more compliant and satisfied with CPAP. Change in IIEF-5 with CPAP treatment was negatively correlated (Pearson coefficient) with OxiMin (r=-0.374), and positively correlated with adherence to CPAP treatment (r=0.689). In conclusion, in selected patients, CPAP treatment for OSAS may by itself have a positive effect on erectile function by improving respiration during sleep. Predictors of erectile improvement include high RDI, low OxiMin, and CPAP compliance.     

Cardiac function in obstructive sleep apnea patients following uvulopalatopharyngoplasty.

Obstructive sleep apnea syndrome (OSAS) is associated with severe cardiac arrhythmias and conduction abnormalities. Cor pulmonale and right-sided heart failure may ensue. Uvulopalatopharyngoplasty (UPPP) is one of several treatment modalities suggested for OSAS. Tracheotomy and CPAP treatment in adult OSAS patients and adenotonsillectomy in children with OSAS were shown to lead to improvement in some cardiac parameters. Cardiac function was prospectively evaluated in 19 OSAS patients before and after UPPP. No significant changes after surgery were noted on electrocardiographic studies. Improvement in global and regional function of both ventricles was seen in 91% of the patients. A trend toward significant elevation in left ventricular ejection fraction and a statistically significant increase in right ventricular ejection fraction were observed (45% +/- 9% to 50% +/- 7% [p = 0.007]). Our results support performance of UPPP in selected OSAS patients for relief of potentially life-threatening cardiac pathologies.     

Transpalatal advancement pharyngoplasty outcomes compared to uvulopalatopharyngoplasty

Objectives: To treat obstructive sleep apnea, transpalatal advancement pharyngoplasty (PA) increases retropalatal airway size more than UPPP alone. In order to evaluate how a newly modified PA technique affects objective clinical outcomes, we compared a group of patients following PA to a control group following UPPP. Study Design: Retrospective matched PA and UPPP case series.Methods: Surgical records were reviewed for all individuals having PA since January 2000 (n = 44) and UPPP (n = 85). Clinical records were reviewed for Malampatti classification, tonsil size, polysomnography, and cardio-respiratory studies. Friedman stage was retrospectively reclassified. PA with Friedman Stage 3 were then matched with UPPP controls based on surgical procedures performed (palatal surgery alone or palatal plus hypopharyngeal surgeries).Results: PA (n = 27) and UPPP (n = 35) did not differ in baseline AHI (49.4 vs 50.8 events/hr), age (48.4 vs 46.6 years), or BMI (31.2 vs 32.8 kg/M2), respectively. Surgical procedures in the PA and UPPP groups were palate alone (38 and 49%) and combined hypophayrngeal (62 and 51%), respectively. Both groups showed a significant improvement in postoperative AHI with AHI lower following PA (20.8 vs 32.9 events/hr, P < 0.05) despite less favorable Friedman Stage. For patients with Friedman Stage 3, absolute reduction in AHI was greater with PA than UPPP (28.7 vs 8.5 events/hr, P < 0.02). Odds ratio of having an AHI <20 events/hr with PA compared to UPPP was 3.48 (95% CI, 1.2, 9.9)Conclusions: Data support that technique of palatopharyngoplasty affects polysomnographic outcomes in OSA. PA may offer additional improvement over UPPP alone.     

小下颌畸形梗阻性睡眠呼吸暂停综合征的整复治疗

我们采用下颌骨颏部截骨前移加植骨术治疗１５例小下颌畸形所致的梗阻性睡眠呼吸暂停综合征（Ｏｂｓｔｒｕｃｔｉｖｅｓｌｅｅｐａｐｎｅａｓｙｎｄｒｏｍｅ下简称ＯＳＡＳ）。通过前移下颌骨颏部及附着于截骨块上的颏舌肌，以扩大口腔容积和舌根部的呼吸道，消除了上呼吸道阻塞，治愈了ＯＳＡＳ并改善了患者的容貌。     

Regulation of brain-derived neurotrophic factor (BDNF) during sleep apnoea treatment

BACKGROUND: Patients with obstructive sleep apnoea syndrome (OSAS) often display persistent cognitive dysfunction despite effective treatment with continuous positive airway pressure (CPAP). Brain-derived neurotrophic factor (BDNF) is a key mediator of memory and cognition, but its regulation in OSAS and during CPAP treatment is unknown. METHODS: Serum and plasma BDNF concentrations, BDNF secretion by peripheral blood mononuclear cells, and overnight polysomnography were evaluated in 17 men with newly diagnosed OSAS (as defined by a respiratory disturbance index of >10/hour with >70% obstructive events and corresponding daytime symptoms) and 12 healthy control men. In the patients all the parameters were monitored after 1 night and 3 months of CPAP treatment. RESULTS: There was no significant difference in baseline serum BDNF, plasma BDNF, or spontaneous BDNF secretion by peripheral blood mononuclear cells between untreated patients and controls. After 1 night of CPAP treatment there was a steep fall in median serum BDNF (from 18.0 ng/ml to 4.1 ng/ml) and plasma BDNF (from 58.7 pg/ml to 22.0 pg/ml) concentrations. Following 3 months of treatment BDNF concentrations did not return to baseline. In contrast, BDNF secretion was not suppressed by CPAP treatment. CONCLUSIONS: Patients with untreated OSAS have normal serum and plasma BDNF levels. CPAP treatment is associated with a rapid decrease in serum and plasma BDNF levels which may reflect enhanced neuronal demand for BDNF in this condition.     

Somnofluoroscopy: its role in the selection of candidates for uvulopalatopharyngoplasty

The purpose of this study was to evaluate the efficacy of somnofluoroscopy in the selection of candidates for uvulopalatopharyngoplasty (UPPP). Somnofluoroscopy is a lateral fluoroscopic examination of the upper airway with synchronous polysomnography that provides information about the dynamic function of the airway and the level of stenosis or occlusion during sleep. Somnofluoroscopies were performed preoperatively in 26 consecutive patients undergoing UPPP. Preoperative and postoperative polysomnographic data were obtained on each patient. On review of the somnofluoroscopic recordings, two levels of the airway were considered: level 1, above the horizontal plane through the midportion of body of the second cervical disk, and level 2, below this plane. The examinations were then scored for the following: (A) most narrow level of airway during wakefulness, (B) first level(s) of airway to collapse during apnea, and (C) all levels of the airway to collapse during apnea. It was shown that patients whose narrowest part of the upper airway is at level 1 and whose first point of airway collapse during apnea episodes is at level 1 are good candidtates for the UPPP. Only three of 15 patients in this group did not respond to the operation. Patients with other patterns are uniformly poor candidates for this procedure. Results are encouraging but preliminary because of the small number of patients. It appears that somnofluoroscopy is a reliable selection criterion for UPPP in patients with obstructive sleep apnea.     

Palatal and tongue base surgery for surgical treatment of obstructive sleep apnea: a prospective study.

OBJECTIVE: To assess the effect of concurrent uvulopalatopharyngoplasty (UPPP) and hypopharyngeal procedures in obstructive sleep apnea (OSA) patients with diffuse airway narrowing. STUDY DESIGN AND SETTING: Forty-eight patients were treated surgically by a single surgeon in private practice over 2 years. Symptoms, Epworth score, and polysomnographic outcome were assessed preoperatively and postoperatively. The Friedman staging system was applied. UPPP with genioglossus advancement, hyoid suspension, or radiofrequency treatment was carried out. RESULTS: In 37 patients with complete data, the average apnea-hypopnea index (AHI) was reduced from 46.5 +/- 24.8 to 14.9 +/- 16.8. The Epworth score was reduced from 12.1 +/- 4.9 to 6.7 +/- 3.7. Most patients reported improved sleep quality, alertness, memory, concentration, and mood. CONCLUSION: Successful outcome, defined by symptom and AHI reduction, was achieved with multilevel surgery for most patients with advanced Friedman stages 2 and 3. SIGNIFICANCE: Multilevel surgery seems effective in treating severe OSA patients with diffuse airway narrowing. EBM rating: C-4.     

Effect of body position on tongue posture in awake patients with obstructive sleep apnoea

BACKGROUND: Snoring and obstructive sleep apnoea (OSA) are worse or may only occur in the supine position. The effect of body position on upper airway size has been reported, but the effect on tongue posture has not previously been examined. METHODS: Detailed measurements were made of tongue posture from upright and supine lateral cephalograms on 24 men with OSA and 13 men with non-apnoeic snoring matched for age, body mass index, and craniofacial skeletal pattern. Patients with OSA had apnoea/hypopnoea indices (AHI) of > 50/hour and/or apnoea indices (AI) of > 25/hour while non-apnoeic snorers had AHI of < 10/hour and AI of < 5/hour. RESULTS: In non-apnoeic snorers the tongue depth measurements for the superior-posterior portion of the tongue were larger in the supine than in the upright position (p < 0.05). There was no significant difference in tongue depth measurements between the upright and the supine position in the patients with OSA. CONCLUSIONS: When awake patients with OSA move from the upright to the supine position they maintain their upright tongue posture which may tend to protect against upper airway collapse secondary to the increased gravitational load on the tongue. In contrast, when awake non-apnoeic snorers move from the upright to the supine position a significant dorsal movement in the superior-posterior portion of the tongue is observed.


     

An adjunctive method of radiofrequency volumetric tissue reduction of the tongue for OSAS.

OBJECTIVES: Temperature-controlled radiofrequency volumetric reduction (TCRF), a minimally invasive procedure, has been used to treat tongue base obstruction in Obstructive Sleep Apnea Syndrome (OSAS). An adjunctive method was objectively evaluated. METHOD: A prospective, nonrandomized clinical study was undertaken on 20 consecutive OSAS patients with isolated tongue base obstruction. Under local anesthesia, multiple lesions of the ventral tongue (genioglossus insertion) and dorsal tongue were given at each treatment session. A visual analog scale was used to assess changes in speech and swallowing. Polysomnography and Epworth Sleepiness Scale (ESS) were used to assess outcome. Patients were maintained on nasal continuous positive airway pressure after each treatment. RESULTS: Patients received a mean 4.6 +/- 0.6 treatments for a mean total of 7915 +/- 1152 joules. There was no significant change in speech or swallowing at 3 months after completion of treatment. Patients reported a significant decrease in sleepiness with a mean change in ESS from 12.4 +/- 2.9 to 7.3 +/- 3.0 (P < 0.001). Mean apnea/hypopnea index decreased from 35.1 +/- 18.1 to 15.1 +/- 17.4 (P < 0.001). Transient mild to moderate pain and swelling occurred after each treatment. There were no significant complications (ulceration, paresthesia, infection). CONCLUSION: TCRF can successfully treat the OSAS patient with tongue base obstruction. Combined treatment of the ventral (genioglossus insertion) and dorsal tongue appears safe and may improve outcome with less total energy when compared with traditional dorsal-only applications.     

Safety of uvulopalatopharyngoplasty as outpatient surgery.

OBJECTIVE: Determine the admission rate and characterize the complications in uvulopalatopharyngoplasty (UPPP) patients scheduled to have outpatient surgery. STUDY DESIGN AND SETTING: Retrospective review of patients undergoing UPPP between 2000 and 2004 in a tertiary care setting. RESULTS: UPPP alone or in conjunction with tonsillectomy, septoplasty, or supraglottoplasty was carried out in 110 patients. Average preoperative respiratory disturbance index (RDI) was 35. Admission was required in 20 (18%) patients whereas 90 (82%) were discharged on the day of surgery. Admission due to desaturation was noted in 3 (3%) patients. The most common reasons for admission included pain and nausea. There were no major complications. CONCLUSIONS: Careful preoperative selection of patients should permit many patients to undergo UPPP as outpatient surgery. Factors requiring admission may be assessed in the early postoperative period. The rate of respiratory events requiring postoperative admission after UPPP is low. SIGNIFICANCE: UPPP can be carried out safely on an outpatient basis. EBM rating: C-4.