Study for Clinical Efficacy of Sleep Surgery in Treatment of Patients with Moderate-Severe Obstructive Sleep Apnea

Woo Hyun Lee; Seungyoung Oh; Hoon Oh; Yong Kyun Park; Sang Gi Min; Ji Ho Shin; Hyun-Jik Kim

doi:10.18787/jr.2017.24.1.20

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Lee, Oh, Oh, Park, Min, Shin, and Kim: Study for Clinical Efficacy of Sleep Surgery in Treatment of Patients with Moderate-Severe Obstructive Sleep Apnea

Original Article

J Rhinol 2017;24(1):20-25.

Published online: 8 January 2017

DOI: https://doi.org/10.18787/jr.2017.24.1.20

Study for Clinical Efficacy of Sleep Surgery in Treatment of Patients with Moderate-Severe Obstructive Sleep Apnea

Woo Hyun Lee, MD¹, Seungyoung Oh, MD¹, Hoon Oh, MD², Yong Kyun Park, MD², Sang Gi Min, MD², Ji Ho Shin, MD², Hyun-Jik Kim, MD²

¹Department of Otolaryngology, National Police Hospital, Seoul, Korea

²Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea

³Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul, Korea

교신저자：김현직, 03080 서울 종로구 대학로 101 서울대학교 의과대학 이비인후과학교실 Tel: +82-2-6299-3128, Fax: +82-2-825-1765, E-mail: hyunjerry@snu.ac.kr

Revised 20 June 20168 November 2016 Accepted 8 December 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background and Objectives:

Surgical treatment is considered as a secondary treatment option for obstructive sleep apnea (OSA). This study was performed to determine whether surgical treatment can be considered in patients with moderate-severe OSA as a treatment modality. Materials and Method: A total of 127 patients with moderate-severe OSA were retrospectively enrolled. The anatomic narrowing sites were mainly evaluated using cephalometry and drug induced sleep endoscopy (DISE), and then multilevel surgeries were performed.

Results:

Both uvula and soft palate were the most frequent narrowing sites and a total of 110 patients showed upper airway narrowing more than two anatomic structures. A total of 79 patients (62.1%) were categorized as responders and 48 patients (39.1%) were non-responders. After multilevel sleep surgeries, patients’ subjective symptoms and sleep parameters were sig-nificantly improved. However, AHI was not considerably decreased. Non-responders to sleep surgeries showed relatively higher rates of severe OSA and body mass index. Tongue base narrowing, incomplete corrections of nasal pathologies and soft palate were significant factors for lower success rates.

Conclusion:

We estimate that sleep surgery might be a therapeutic option for moderate to severe patients with OSA. A delicate preoperative evaluation for upper airway narrowing is necessary to adapt sleep surgery to these patients.

Keywords: Obstructive sleep apneaㆍ, Sleep surgeryㆍ, Drug induced sleep endoscopyㆍ, Severityㆍ, Efficacy

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Fig. 1.

The obstruction site and its frequency through the DISE examination ( A), Total number of narrowing sites in each pa-tient ( B).

Fig. 2.

Type of surgeries which were conducted to patients with moderate and severe OSA.

Fig. 3.

Patients’complaints after surgery.

Fig. 4.

The findings of anatomic structures in non-responders ( N=48) at 3 months after sleep surgeries.

Table 1.

Changes in the sleep-related parameters after sleep surgery

	Preoperative	Postoperative	p-value
ESS score	11.7±4.3	6.7±2.6	∗
VAS for snoring	6.6±1.2	2.7±0.5	∗
VAS for apnea	8.1±2.8	4.2±0.6	∗
AHI	25.8±9.2	20.1±9.2
ODI	20.1±6.9	14.4±6.5	∗
Mean O₂ saturation (%)	88.1±5.2	94.5±4.3	∗
Valid sleep time (time)	381.4±41.2	412±38.9	∗
Snoring intensity (dB)	50.4±19.2	32.6±11.5	∗

^∗ : p-value ＜ 0.05.

ESS: Epworth sleepiness scale, VAS: Visual analgue scale, AHI: Apnea-hypopnea index, ODI: Oxygen desaturation index

Table 2.

The comparision of preoperative sleep parameters between responders and non-responder group

	Responder ( N=74) N	Non-responder ( N=53)	p-value
BMI	24.7±3.8	29.8±4.6	∗
ESS score	14.2±7.3	13.8±4.2
AHI	27.9±6.5	29.3±5.1
ODI	23.5±3.9	24.9±4.7
Mean O₂ saturation (%)	87.3±4.2	88.6±7.6

^∗ : p-value ＜0.05.

BMI: Body mass index, ESS: Epworth sleepiness scale, AHI: Apnea-hypopnea index, ODI: Oxygen desaturation index

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