Adherence of obstructive sleep apnea syndrome patients to continuous positive airway pressure in a public service,

IntroductionThe standard therapy for obstructive sleep apnea syndrome (OSAS) is continuous positive airway pressure (CPAP), but its correct and frequent use is essential to control the disease.PurposeTo analyze adherence to CPAP among patients with OSAS treated in a multidisciplinary outpatient clinic of a public tertiary hospital.MethodsThis was a retrospective study evaluating 156 patients with OSAS who underwent polysomnography for CPAP titration from 2008 to 2011. The patients were divided into two groups, those with good adherence to CPAP (a mean use of four or more hours per night) and those with poor adherence. The groups were compared regarding the following data: gender, age, body mass index, associated diseases, AHI at diagnostic polysomnography, and pressure (cmH₂O) suggested by titration polysomnography.Results125 patients were analyzed, and it was observed that 82 of the patients (65%) had good adherence, whereas 43 (35%) showed poor adherence. Comparison between groups revealed that patients with a higher apnea-hypopnea index (AHI) were those who better adhered to treatment with CPAP.Conclusionsthe rate of adherence to CPAP among OSAS patients undergoing clinical monitoring at a public service was 65%. Patients with a higher AHI were those who adhered better to treatment with CPAP.© 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.     

Hyoidthyroidpexia as a treatment in multilevel surgery for obstructive sleep apnea

CONCLUSION: This type of surgery is effective in patients with obstructive sleep apnea syndrome (OSAS), but may not be effective in obese patients or those with a preoperative apnea hypopnea index (AHI)>35. For these reasons, the careful study and selection of patients is fundamental in the surgical treatment of OSAS. OBJECTIVES: Evaluation of the efficacy of hyoid surgery combined with oropharynx and nose surgery in the treatment of OSAS. SUBJECTS AND METHODS: A total of 109 OSAS patients underwent hyoidthyroidpexia as a treatment in multilevel surgery. Before surgery all patients were treated with continuous positive airway pressure (CPAP) therapy for at least 6 months and underwent preoperative and postoperative polysomnography. The preoperative examination was composed of upper airways endoscopy, lateral cephalometric radiograph, calculation of body mass index (BMI), and subjective analysis of daytime sleepiness. RESULTS: In all, 67/109 patients (61.5%) with postoperative AHI<20 were defined as 'responders', while the other 42 patients (38.5%) were defined as 'non-responders'. The correlation between preoperative BMI and postoperative AHI revealed that non-responders had a much higher average BMI compared with responders. Moreover, when analyzing median preoperative and postoperative AHI, it emerged that non-responders had a much higher preoperative AHI compared with responders.     

Surgical treatment of patients with severe obstructive sleep apnea syndrome

No standard indications currently exist for surgical treatment of severe obstructive sleep apnea syndrome (OSAS). We treated 15 patients with severe OSAS surgically, evaluated surgical indications, and evaluated surgical success. We retrospectively reviewed 15 cases of surgery for OSAS in which polysomnography met 2 or more criteria for the following surgical indications: (1) apnea hypopnea index (AHI) > or = 50, (2) minimum SpO2 below 80%, and (3) enlarged tonsils (grade III, Mackenzie's classification). Among the 15, mean AHI was 85.1. Surgery was done under general anesthesia, with uvulopalatopharyngoplasty (UPPP) in 13 and tonsillectomy alone in 2. Postoperative AHI was measured in 9 patients. According to Nishimura's criteria for assessing surgical success, improvement was "excellent" in 5, "good" in 1, "fair" in 1, and "poor" in 2. When we compared preoperative and postoperative use of continuous positive airway pressure (CPAP) in 7, we found that surgery decreased CPAP requirements. Surgical success was assessed in patients requiring CPAP and improvement was "excellent" in 5, "good" in 1, and "fair" in 1. In conclusion, surgical indications for severe OSAS, including the criterion of enlarged tonsils, were useful. Surgery decreased CPAP requirements and the degree of improvement in this requirement and AHI was valuable in assessing surgical success.     

Comparison of combined operation and nasal CPAP treatments for sleep disorders

Uvulopalatopharyngoplasty (UPPP) and nasal CPAP are used for the treatment of obstructive sleep apnea syndrome (OSAS) in different institutions. Although OSAS results from an abnormality in the soft-palate, almost no reports have been made on the selection of UPPP or nasal CPAP procedures according to the type of abnormality. The most probable reason for this is that a comparison of treatment methods in individuals cases is difficult. We performed CPAP titration before and after operations, and compared the treatment methods, and evaluated the medical therapy. METHOD: A sleep polygraph was performed on the first night, and cases diagnosed as OSAS received CPAP titration on the second night. The blocked region was identified by endoscopic examination. The results of the operation were evaluated after 1-2 months, and apnea hypopnea index (AHI) improvements of less than 50% received a second CPAP titration. RESULTS: The operation results were poor for cases where endoscopic examination showed full-circumference palatal type, and good for soft palate and tonsillar type abnormalities. When endoscopic examinations were performed in conjunction with nasal CPAP, the treatment was observed to act on the soft palate and expand the air way in all cases. Nasal CPAP was effective in cases with full-circumference palatal abnormalities because in these cases, the pressure was caused by inflamma. Combined medical treatments were effective in cases where CPAP alone was ineffective because the pressure was too high.     

Clinical indication of nasal surgery for the CPAP intolerance in obstructive sleep apnea with nasal obstruction

ObjectiveThe role of isolated nasal surgery for obstructive sleep apnea (OSA) patients with nasal obstruction, especially for an intolerance for continuous positive airway pressure (CPAP), is unclear. The aim of this study was to assess the effects of surgery for OSA patients with symptomatic nasal obstruction and CPAP intolerance.MethodRetrospectve comparative study.1037 OSA patients with apnea-hypopnea index (AHI) ≥ 20 were enrolled. Case-control study was performed between the male apnea patients undergoing nasal surgery: surgery group (n = 43) and the pair-matched apnea patients for age, sex, body mass index, and race: control group (n = 43). The surgery group suffering from nasal obstruction could not use continuous positive airway pressure, and the CPAP group free from nasal obstruction could use it successfully.ResultsIn surgery group, surgery significantly decreased the nasal resistance and Epworth sleepiness scale scores without changing the AHI. Surgery significantly increased the nadir of oxygen saturation and shortened the apnea-hypopnea duration. Although all of the surgery group failed to use positive airway pressure preoperatively, the 40 patients of the 43 CPAP intolerance patients were able to use CPAP postoperatively. The resting three patients were cured OSA or changed the treatment to oral appliance(OA). For both groups, the cutoff nasal resistance for differentiating the failure of positive airway pressure and its success was 0.31 Pa/cm³/s.ConclusionIsolated nasal surgery is effective for an intolerance of positive airway pressure in sleep apnea with nasal obstruction presumably by decreasing nasal resistance.     

Nasal resistance for determinant factor of nasal surgery in CPAP failure patients with obstructive sleep apnea syndrome

OBJECTIVES: Given that criteria for nasal surgery in individuals with obstructive sleep apnea syndrome (OSAS) have not been proposed, we investigated the effectiveness of nasal surgery for CPAP failure in patients with both severe OSAS and nasal obstruction. PATIENTS AND METHODS: Conventional nasal surgery was performed in 12 patients who were refractory to treatment by CPAP. The subject group consisted of 12 males (mean age, 54.2 +/- 9.2 years; range 39-66 years). The effect of nasal surgery was evaluated with data from preoperative and postoperative polysomunography. The nasal resistance value was first deduced to determine which OSAS patients with CPAP failure should undergo nasal surgery, compared to control values. RESULTS: Nasal surgery resulted in a significant decrease in nasal resistance, as measured by rhinomanometry, from 0.57 +/- 0.31 Pa/cm3 /sec to 0.16 +/- 0.03 Pa/cm3/sec and rendered all patients tolerant to CPAP. In addition, the lowest nocturnal oxygen saturation significantly increased from 68.3 +/- 12.1% to 75.3 +/- 7.1% after surgery. Subjectively, Epworth sleepiness scale (ESS) significantly decreased from 11.7 +/- 4.1 to 3.3 +/- 1.3 after surgery, but the number of apnea and hypopnea episodes per hour did not change significantly. In five patients, for whom it was possible to perform a CPAP titration before nasal surgery, the value decreased significantly from 16.8 +/- 1.1 to 12.0 +/- 1.9 cmH2O. The bilateral nasal resistance of the 410SAS patients with CPAP therapy (control group) was 0.24 +/- 0.11 Pa/cm3/sec. The cut off value for differentiation between CPAP failure patients and control group was determined as 0.38 Pa/cm3 /sec. CONCLUSION: Increased nasal resistance is a determinant of CPAP failure, and the surgical correction of severe nasal obstruction should thus be considered to facilitate treatment of OSAS patients with CPAP.     

Effectiveness of multilevel (tongue and palate) radiofrequency tissue ablation for patients with obstructive sleep apnea syndrome

OBJECTIVES: The primary objective is to determine the effectiveness of multilevel (tongue base and palate) temperature controlled radiofrequency tissue ablation (TCRFTA) for patients with obstructive sleep apnea syndrome (OSAS). The secondary objective is to compare multilevel TCRFTA to nasal continuous positive airway pressure (CPAP). STUDY DESIGN AND METHODS: The study is a controlled case series of one investigator's experience with multilevel TCRFTA for patients with OSAS. Twenty-two subjects with mild to severe OSAS, without tonsil hypertrophy, completed multilevel TCRFTA (mean 4.8 tongue base and 1.8 palate treatment sessions) and had both pre- and posttreatment polysomnography. Primary outcomes included change from baseline in apnea/hypopnea index (AHI), daytime somnolence, and reaction time testing measured 2 to 3 months after TCRFTA. Secondary outcomes included change in other respiratory parameters, OSAS related quality of life, and upper airway size. Comparison of 18 patients treated with TCRFTA for mild to moderate OSAS (AHI > 5 and < or = 40) is made with 11 matched patients treated with nasal CPAP for mild to moderate OSAS. RESULTS: Multilevel TCRFTA significantly improved AHI (P = .001), apnea index (P = .02), as well as respiratory and total arousal indices (P = .0002 and P = .01). Significant improvement with moderate or large treatment effect sizes were noted for OSAS related quality of life (P = .01) and daytime somnolence (P = .0001), with a trend toward significant improvement in reaction time testing (P = .06), with mean posttreatment normalization of all three outcome measures. Fifty-nine percent of subjects demonstrated at least a 50% reduction in AHI to less than 20. The targeted upper airway, measured in the supine position, demonstrated a trend toward significant improvement in mean cross sectional area (P = .05) and volume (P = .10). Side effects of TCRFTA were infrequent, mild, and self-limited. No significant correlation between pretreatment parameters and outcome improvement was noted. Nasal CPAP resulted in significant improvement in AHI (P = .0004) to near normal levels, with an associated improvement in OSAS related quality of life (P = .02) and a trend toward significant improvement in daytime somnolence (P = .06). Reaction time testing demonstrated no significant improvement (P = .75). No significant differences were seen for change in AHI, OSAS related quality of life, daytime somnolence, or reaction time testing between multilevel TCRFTA and CPAP. CONCLUSION: Multilevel (tongue base and palate) TCRFTA is a low-morbidity, office-based procedure performed with local anesthesia and is an effective treatment option for patients with OSAS. On average, abnormalities in daytime somnolence, quality of life, and reaction time testing demonstrated improvement from baseline and were normalized after treatment. Polysomnographic respiratory parameters also demonstrated significant improvement with multilevel TCRFTA.     

Altered positional regulation of nasal patency in patients with obstructive sleep apnoea syndrome

We assessed the regulation of nasal patency supine in subjects with obstructive sleep apnoea syndrome (OSAS) compared to healthy controls. Healthy subjects increase nasal obstruction when changing body position from sitting to supine, possibly due to increased hydrostatic pressure in the head supine. Limited data indicate that this response is altered in patients with OSAS, suggesting that supine nasal patency is actively regulated. This study examined the nasal response to recumbent body position using acoustic rhinometry in OSAS patients and healthy controls. Twenty subjects (16 men and 4 women, mean age 55 ± 16 years), with diagnosed OSAS [mean apnoea hypopnoea index (AHI) 46 ± 22 events/h] without nasal obstruction and continuous positive airway pressure (CPAP)-naive, underwent measurement of intra-nasal cross sectional area by acoustic rhinometry at sitting and after 5 min supine. Twenty healthy controls (13 men, 7 women, mean age 35 ± 9 years) were also included in the study. In the patients with OSAS, the mean minimal cross sectional area (MCA, left + right nasal cavity) was unchanged between sitting (1.18 ± 0.41 cm²) and supine (1.21 ± 0.35 cm², P = 0.5). In the healthy controls, the mean MCA decreased from 1.06 ± 0.18 to 0.94 ± 0.21 cm² supine, P = 0.01. This study showed that the normal decrease in nasal patency following a change in body position from sitting to supine is absent in patients with OSAS. The results indicate that there is an active regulation of supine nasal patency.     

Statistical model for postoperative apnea–hypopnea index after multilevel surgery for sleep-disordered breathing

The objective of the study was to formulate a statistical model for postoperative apnea–hypopnea index (AHI) 3 and 12 months after multilevel surgery using the predictors preoperative AHI, body mass index (BMI) and age. The study design was a prospective cohort study. Data of 144 patients were collected prospectively 3 and 12 months after multilevel surgery for obstructive sleep apnea syndrome (OSAS) or upper airway resistance syndrome with excessive daytime sleepiness. The primary endpoint postoperative AHI and the secondary endpoint success according to the Sher criteria (postoperative AHI <20 h and >50% reduction of preoperative AHI) were modeled with multiple linear and logistic regression using the predictors preoperative AHI, BMI, age and the indicator whether the patient had undergone a tonsillectomy. Preoperative AHI and tonsillectomy had a highly significant positive influence on postoperative AHI after 3 months, whereas the influence of preoperative BMI was only marginally significant but numerically rather large. Age was not a significant decisive factor. The success according to the Sher criteria was highly significantly determined by the circumstance whether the patient had undergone a tonsillectomy, but not by the other predictors preoperative BMI or age. The responder rate with and without tonsillectomy was 58 and 19%, respectively. The odds ratio to be a responder if a tonsillectomy was conducted was 5.7. This study provides statistical models predicting postoperative AHI and success according to the Sher criteria after multilevel surgery for OSAS.     

阻塞性睡眠呼吸暂停综合征与不同体位下鼻阻力的关系

目的 :探讨不同体位下鼻阻力的变化及其与阻塞性睡眠呼吸暂停综合征 (OSAS)的关系。方法 :对 14例正常人、2 0例单纯鼾症和 4 0例OSAS患者进行坐位和仰卧位的鼻阻力检测 ,并行多导睡眠呼吸监测。将单纯鼾症和OSAS患者按有无鼻腔疾病分成阴性组和阳性组。结果 :①单纯鼾症鼻阴性组以及OSAS鼻阴性组的鼻阻力明显高于正常组 (P <0 .0 5 )。②OSAS鼻阳性组坐位与卧位鼻阻力明显高于单纯鼾症鼻阳性组 (P <0 .0 5 )。③各分组卧位的鼻阻力高于坐位(P <0 .0 5 ) ,OSAS鼻阴性组和阳性组之间差异有极显著性意义 (P <0 .0 1)。④OSAS患者中 ,鼻阳性组呼吸暂停和低通气指数、觉醒指数、鼾声指数高于鼻阴性组 ,最低血氧饱和度低于鼻阴性组 (P <0 .0 5 )。结论 :单纯鼾症与OSAS患者鼻阻力都较正常人增加 ,且仰卧位时较坐位时明显增加 ;鼻阻力可能与OSAS发病有关     

Influence of upper airway narrowing on the effective continuous positive airway pressure level

BACKGROUND AND OBJECTIVES: The aim of this study was to determine the relationship between the continuous positive airway pressure (CPAP) titration level and upper airway variables in obstructive sleep apnea syndrome (OSAS). SUBJECTS AND METHODS: Forty-seven patients suffering from OSAS were enrolled in this study. They were asked to answer a questionnaire about nasal stuffiness and mouth breathing, and the degree of tonsillar hypertrophy and shape of the oropharyngeal inlet were evaluated. The minimal cross-sectional area (MCA) of the nasal cavity was measured with acoustic rhinometry, followed by optimal CPAP level titration. We compared optimal CPAP levels with body mass index (BMI), perceived nasal stuffiness, and anatomic upper airway narrowing. RESULTS: The mean CPAP level was 6.32 +/- 2.17 cm H2O. We found a significant correlation between CPAP levels and BMI (P = .01), apnea-hypopnea index (P = .015), and the degree of tonsillar hypertrophy (P = .011). Furthermore, the CPAP level increased significantly with the MCA on the narrow side of the nasal cavity (P = .038) in patients with a BMI less than 25. Other variables, such as subjective symptoms and anatomic nasal airway occlusion in obese patients (BMI > or = 25), revealed no correlation with the CPAP level. CONCLUSIONS: Upper airway occlusion including nasal obstruction or tonsillar hypertrophy might increase the effective CPAP level.     

Unattended automated titration to determine therapeutic continuous positive airway pressure in patients with obstructive sleep apnea

Recently, devices which use a new technology that automatically titrates positive airway pressure have become available. Such devices continually adjust the pressure to maintain airway patency. In this paper, unattended automated titration to determine the therapeutic continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea was evaluated to ascertain of it was a feasible titration to determine the therapeutic CPAP. Thirty patients participated in this study with obstructive sleep apnea syndrome defined by an apnea hypopnea index > 20/h. Automated titration during full polysomnography was performed in the hospital using auto CPAP devices (Autoset T, RESMED Co, Australia). During titration, there was no direct supervision by a technician. The titration method was as follows. Data obtained during the use of auto CPAP devices and polysomnography were used to provide a fixed single pressure for subsequent treatment. After determining the therapeutic continuous positive airway pressure, the efficacy of the patient's CPAP device was reconfirmed during full polysomnography. The results were, 1) Proper fixed single therapeutic pressure could be determined with this unattended automated titration, consequently apnea and sleep structure could be improved (Total sleep time, Sleep efficiency, %Stage 3 + 4, Apnea index, Apnea hypopnea index, Arousal index, Lowest SpO2, and Duration of SpO2 less than 90% were improved statistically (p < 0.05)). 2) The 95th percentile airway pressure of the auto CPAP device should be applied for the therapeutic pressure. 3) Automated titration during full polysomnography should be performed using auto CPAP devices. 4) After determining the therapeutic CPAP, the efficacy of the patient's CPAP device should be reconfirmed during full polysomnography. 5) This method of titration was useful at the institution without attendant technician intervention.     

睡眠呼吸暂停综合征术前经鼻正压通气的治疗

OBJECTIVE: Preoperative nasal continuous positive airway pressure(NCPAP) treatment was used as a substitute for protective tracheostomy before UPPP surgery in 42 patients with severe obstructive sleep apnea syndrome(OSAS) from 1994 to 1996. METHODS: Fifty-two patients operated on three years before this period served as control group. All cases were diagnosed as severe OSAS by polysomnography (PSC). RESULTS: There were no statistical difference in main parameters between two groups. Seven cases in the control group underwent protective tracheostomy whose apnea and hypopnea index(AHI) was 28.4-83.5 and lowest saturation oxygen (SaO2) were 7%-32%. One patient underwent emergency tracheostomy due to life-threatening situation during uvulopalatopharyngoplasty (UPPP). There were 9 similarly severe cases who did not undergo protective tracheostomy in NCPAP treatment group. All patients underwent preoperative 5-20 day NCPAP treatment in treatment group. The average positive pressure was 1.16 kPa(11.85 cmH2O). There were significant difference in main parameters between the two groups. The AHI, SaO2 and sleep structure were evidently improved. UPPP was safely performed without protective tracheostomy and any complications in all patients with NCPAP treatment. CONCLUSION: This result implys that NCPAP treatment could be used as a substitute for protective tracheostomy before UPPP in severe OSAS.     

The effects of upper airway surgery for obstructive sleep apnea on nasal continuous positive airway pressure settings

OBJECTIVES/HYPOTHESIS: The objectives were to determine whether upper airway surgery lowers nasal continuous positive airway pressure (CPAP) settings for patients who require CPAP postoperatively for unresolved obstructive sleep apnea and to assess CPAP tolerability after upper airway surgery. STUDY DESIGN: Retrospective chart review. METHODS: Patients who underwent upper airway surgery with preoperative and postoperative polysomnography at the University of Alabama at Birmingham (Birmingham, AL) between 1995 and 2000 were the focus of the study. Upper airway surgery was defined as uvulopalatopharyngoplasty alone or in addition to septoplasty and turbinoplasty. Recommended CPAP settings were recorded from preoperative and postoperative polysomnography studies to determine whether CPAP settings were decreased following surgery. A response to surgery was defined as a decrease of the recommended CPAP setting by at least 1 cm of water. A telephone interview was conducted to determine whether upper airway surgery improved CPAP comfort. RESULTS: In 51.4% of the patients, CPAP settings were decreased following surgery. Continuous positive airway pressure settings were increased in 28.6% of patients and unchanged in 20%. Of the six patients who consistently used CPAP before and after surgery, four reported increased comfort postoperatively. CONCLUSION: Upper airway surgery does not predictably reduce CPAP settings in the patient who requires postoperative CPAP for unresolved obstructive sleep apnea. Upper airway surgery may improve CPAP tolerability.     

A comparison of the long-term outcome and effects of surgery or continuous positive airway pressure on patients with obstructive sleep apnea syndrome

OBJECTIVES: To compare the long-term (3-year) outcome and effects of continuous positive airway pressure (CPAP) and extended uvulopalatoplasty (EUPF) treatment on patients with obstructive sleep apnea syndrome. METHODS: Eighty-four patients who received CPAP titration and bought a CPAP machine to use from March 2000 to October 2001 were included as the CPAP group. Another 55 patients who underwent EUPF surgery were included as the EUPF group. Overnight polysomnography was performed 6 months and 3 years after CPAP titration or EUPF. The disease-specific questionnaire-Snore Outcome Survey (SOS), Epworth Sleepiness Scale (ESS), and the generic health questionnaire-MOSF-36 were administered at the 6-month and 3-year follow-up examinations. RESULTS: The age, body mass index, respiratory disturbance index, and ESS before treatment were higher in the CPAP group. The snore index was higher in the surgery group. Fifty-four patients (64.3%) in CPAP group continued treatment for 6 months; the success rate for EUPF at 6 months was 82%. The polysomnographic variables improved significantly in both groups. Improvements in the SOS and ESS scores were better in surgery group than the CPAP group. The subscales of SF-36 in surgery group were more than those in CPAP group. CONCLUSIONS: EUPF had a better effect on snoring than CPAP 6 months after treatment in patients with obstructive sleep apnea syndrome (OSAS). This effect had gradually declined at the 3-year follow-up examination. Improvement in the quality of life of OSAS patients receiving EUPF is equal to those receiving CPAP treatment.     

悬雍垂腭咽成形术后持续正压通气治疗

观察悬雍垂腭咽成形术（ｕｖｕｌｏｐｌａｔｏｐｈａｒｙｇｏｐｌａｓｔｙ,ＵＰＰＰ）后疗效不佳的阻塞性睡眠呼吸暂停综合征（ｏｂｓｔｒｕｃｔｉｖｅｓｌｅｅｐａｐｎｅａｓｙｎｄｒｏｍｅ,ＯＳＡＳ）患者为手术组行持续正压通气（ｃｏｎｔｎｕｏｕｓｐｏｓｉｔｉｖｅａｉｒｗａｙｐｒｅｓｓｕｒｅ,ＣＰＡＰ）治疗的效果。方法１５例ＵＰＰＰ术后呼吸暂停低通气指数（ａｐｎｏｅａ－ｈｙｐｏｎｏｅａｉｎｄｅｘ,ＡＨＩ）仍大于     

Effects of nasal surgery on sleep quality in obstructive sleep apnea syndrome with nasal obstruction

BACKGROUND: The purpose of this study was to evaluate the effects of nasal surgery on nasal resistance, sleep apnea, and sleep quality in adult male patients with obstructive sleep apnea syndrome (OSAS). A prospective study was performed in OSAS patients who underwent isolated nasal surgery in a tertiary referral center. METHODS: During the 3-year study period, 49 OSAS patients suffering from symptomatic nasal obstruction/impaired nasal breathing underwent the standard polysomnography before and after surgery. Polysomnography along with measures of nasal resistance and daytime sleepiness (the Epworth sleepiness scale [ESS] scores) were reviewed also. RESULTS: Surgery decreased the nasal resistance (0.55 +/- 0.37 Pa/cm(3) per second versus 0.17 +/- 0.19 Pa/cm(3) per second; p < 0.001) and ESS scores (11.7 +/- 4.1 versus 3.3 +/- 1.3; p < 0.001), without changes in the apnea-hypopnea index (AHI; 44.6 +/- 22.5 versus 42.5 +/- 22.0). Surgery increased nadir oxygen saturation (76.2 +/- 10.9% versus 78.8 +/- 8.1%; p < 0.01), shortened apnea-hypopnea duration (averaged/maximum; 33.5 +/- 7.3/61.1 +/- 46.0 versus 28.8 +/- 7.4/47.3 +/- 36.1 second; p < 0.05/p < 0.01), and improved sleep quality. CONCLUSION: The results suggest that nasal surgery is useful for lowering nasal resistance, ameliorating sleep-disordered breathing, and improving sleep quality and daytime sleepiness in OSAS.     

Allergic Rhinitis does not Constitute a Risk Factor for Obstructive Sleep Apnea Syndrome

Obstructive sleep apnea syndrome (OSAS) is a condition characterized by recurrent episodes of obstruction of the upper airway. The aim of this study was to evaluate whether nasal obstruction due to allergic rhinitis constitutes a risk factor for OSAS. Patients (n = 119) presenting typical symptoms of sleep apnea were tested for OSAS using polysomnography. Additionally all patients were tested in vivo and in vitro (including nasal eosinophilic cationic protein) for allergic rhinitis. Examination for allergic rhinitis revealed that 88.3% of all patients had no allergic rhinitis, whereas only 11.7% were diagnosed as allergic. No significant differences in sleeping parameters were observed between allergic and non-allergic patients. Comparison of parameters indicative of relevant OSAS (apnea-hypopnea index [AHI] &gt; 10) revealed that 60% of non-allergic patients had relevant OSAS, compared to only 50% of allergic patients. Investigation of allergic subgroups revealed similar results: no significant differences in sleeping parameters or elevated rates of relevant OSAS parameters were observed, especially in perennial allergic rhinitis due to house dust mites. No elevated rates of allergic rhinitis were observed in the studied cohort of patients suffering from sleep apnea or OSAS. Furthermore, no significant differences in sleeping behavior or polysomnography parameters were found on comparing allergic and non-allergic patients. In summary, our data rule out allergic rhinitis as a major risk factor for OSAS.     

Single-session radiofrequency tongue base reduction combined with uvulopalatopharyngoplasty for obstructive sleep apnea syndrome

This study aimed to evaluate the efficacy and safety of single-session radiofrequency tongue base reduction (RTBR) combined with uvulopalatopharyngoplasty (UPPP) for the treatment of obstructive sleep apnea syndrome (OSAS). Sixty-six patients with multilevel obstruction underwent single-session RTBR combined with UPPP. Snoring, Epworth sleepiness scale (ESS) and polysomnography were used to assess outcome before and 6 months after treatment. Sixty-six patients completed this study. Snoring level significantly decreased from 8.0 to 4.3. The mean ESS score significantly decreased from 11.4 to 7.5. The mean apnea–hypopnea index decreased significantly from 22.9 to 13.9. The overall success rate of the single-session RTBR combined with UPPP was 53.6%. Postoperative AHI in 50% of patients was normalized (AHI < 5). The success rates for patients with mild, moderate and severe OSAS were 62.5, 46.2 and 57.1%, respectively. There were two adverse effects, one ulceration of the tongue base and one transient taste change. Single-session RTBR combined with UPPP is an effective and safe treatment for OSAS patients with multilevel obstruction. It could be considered as first treatment for OSAS patients with multilevel obstruction, independent of the severity of OSAS.     

Effect of nasal surgery on sleep-related breathing disorders.

OBJECTIVE/HYPOTHESIS: Single cases of patients who have experienced obstructive sleep apnea (OSA) and who recovered completely after nasal surgery have been described in various studies. The purpose of this study was to evaluate the efficacy of only nasal surgery 1) in a group of patients with obstructive sleep apnea and 2) in simple snorers. STUDY DESIGN: A prospective, controlled study with 26 adult patients who underwent nasal surgery as single treatment of their sleep-related breathing disorders. The cases were evaluated based on the severity level of their preoperative Apnea Hypopnea Index (AHI). MATERIAL AND METHODS: Between August 1996 and July 2000, 26 patients who snored and had impaired nasal breathing underwent attended polysomnography in the sleep laboratory as single treatment nasal surgery was performed. Postoperative polysomnographic findings and complications were reviewed. RESULTS: Nineteen of 26 patients (73.1%) were diagnosed as having OSA. Seven patients were simple snorers with an AHI below 10. The surgical response rates, defined as greater than or equal to 50% reduction in the postoperative AHI and a postoperative AHI of less than 20, was 15.8% in the apneics. For the whole group, the AHI decreased postoperatively from 31.6 to 28.9. However, daytime sleepiness improved significantly and arousals decreased significantly in both apneics and simple snorers after nasal surgery. CONCLUSIONS: We conclude that nasal surgery has a limited efficacy in the treatment of adult patients with sleep apnea. Nevertheless, nasal surgery significantly improves sleep quality and daytime sleepiness independent of the severity of obstructive sleep-related breathing disorders.