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Chang JL, Goldberg AN, Alt JA, Alzoubaidi M, Ashbrook L, Auckley D, Ayappa I, Bakhtiar H, Barrera JE, Bartley BL, Billings ME, Boon MS, Bosschieter P, Braverman I, Brodie K, Cabrera-Muffly C, Caesar R, Cahali MB, Cai Y, Cao M, Capasso R, Caples SM, Chahine LM, Chang CP, Chang KW, Chaudhary N, Cheong CSJ, Chowdhuri S, Cistulli PA, Claman D, Collen J, Coughlin KC, Creamer J, Davis EM, Dupuy-McCauley KL, Durr ML, Dutt M, Ali ME, Elkassabany NM, Epstein LJ, Fiala JA, Freedman N, Gill K, Boyd Gillespie M, Golisch L, Gooneratne N, Gottlieb DJ, Green KK, Gulati A, Gurubhagavatula I, Hayward N, Hoff PT, Hoffmann OM, Holfinger SJ, Hsia J, Huntley C, Huoh KC, Huyett P, Inala S, Ishman SL, Jella TK, Jobanputra AM, Johnson AP, Junna MR, Kado JT, Kaffenberger TM, Kapur VK, Kezirian EJ, Khan M, Kirsch DB, Kominsky A, Kryger M, Krystal AD, Kushida CA, Kuzniar TJ, Lam DJ, Lettieri CJ, Lim DC, Lin HC, Liu SY, MacKay SG, Magalang UJ, Malhotra A, Mansukhani MP, Maurer JT, May AM, Mitchell RB, Mokhlesi B, Mullins AE, Nada EM, Naik S, Nokes B, Olson MD, Pack AI, Pang EB, Pang KP, Patil SP, Van de Perck E, Piccirillo JF, Pien GW, Piper AJ, Plawecki A, Quigg M, Ravesloot MJ, Redline S, Rotenberg BW, Ryden A, Sarmiento KF, Sbeih F, Schell AE, Schmickl CN, Schotland HM, Schwab RJ, Seo J, Shah N, Shelgikar AV, Shochat I, Soose RJ, Steele TO, Stephens E, Stepnowsky C, Strohl KP, Sutherland K, Suurna MV, Thaler E, Thapa S, Vanderveken OM, de Vries N, Weaver EM, Weir ID, Wolfe LF, Tucker Woodson B, Won CH, Xu J, Yalamanchi P, Yaremchuk K, Yeghiazarians Y, Yu JL, Zeidler M, Rosen IM. International Consensus Statement on Obstructive Sleep Apnea. Int Forum Allergy Rhinol 2023; 13:1061-1482. [PMID: 36068685 PMCID: PMC10359192 DOI: 10.1002/alr.23079] [Citation(s) in RCA: 62] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.
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Affiliation(s)
- Jolie L. Chang
- University of California, San Francisco, California, USA
| | | | | | | | - Liza Ashbrook
- University of California, San Francisco, California, USA
| | | | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | - Maurits S. Boon
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pien Bosschieter
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Itzhak Braverman
- Hillel Yaffe Medical Center, Hadera Technion, Faculty of Medicine, Hadera, Israel
| | - Kara Brodie
- University of California, San Francisco, California, USA
| | | | - Ray Caesar
- Stone Oak Orthodontics, San Antonio, Texas, USA
| | | | - Yi Cai
- University of California, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | - Susmita Chowdhuri
- Wayne State University and John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Peter A. Cistulli
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David Claman
- University of California, San Francisco, California, USA
| | - Jacob Collen
- Uniformed Services University, Bethesda, Maryland, USA
| | | | | | - Eric M. Davis
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Mohan Dutt
- University of Michigan, Ann Arbor, Michigan, USA
| | - Mazen El Ali
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | - Kirat Gill
- Stanford University, Palo Alto, California, USA
| | | | - Lea Golisch
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | | | | | - Arushi Gulati
- University of California, San Francisco, California, USA
| | | | | | - Paul T. Hoff
- University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver M.G. Hoffmann
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | - Jennifer Hsia
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Colin Huntley
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Sanjana Inala
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Meena Khan
- Ohio State University, Columbus, Ohio, USA
| | | | - Alan Kominsky
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Meir Kryger
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Derek J. Lam
- Oregon Health and Science University, Portland, Oregon, USA
| | | | | | | | | | | | | | - Atul Malhotra
- University of California, San Diego, California, USA
| | | | - Joachim T. Maurer
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Anna M. May
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Ron B. Mitchell
- University of Texas, Southwestern and Children’s Medical Center Dallas, Texas, USA
| | | | | | | | | | - Brandon Nokes
- University of California, San Diego, California, USA
| | | | - Allan I. Pack
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | - Mark Quigg
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Armand Ryden
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Firas Sbeih
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | | | | | | | | | - Jiyeon Seo
- University of California, Los Angeles, California, USA
| | - Neomi Shah
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Ryan J. Soose
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Erika Stephens
- University of California, San Francisco, California, USA
| | | | | | | | | | - Erica Thaler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sritika Thapa
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nico de Vries
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | | | - Ian D. Weir
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Josie Xu
- University of Toronto, Ontario, Canada
| | | | | | | | | | | | - Ilene M. Rosen
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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2
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Martinovic D, Tokic D, Puizina-Mladinic E, Kadic S, Lesin A, Lupi-Ferandin S, Kumric M, Bozic J. Oromaxillofacial Surgery: Both a Treatment and a Possible Cause of Obstructive Sleep Apnea-A Narrative Review. LIFE (BASEL, SWITZERLAND) 2023; 13:life13010142. [PMID: 36676088 PMCID: PMC9866782 DOI: 10.3390/life13010142] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023]
Abstract
Obstructive sleep apnea (OSA) is a chronic, sleep-related breathing disorder. It is characterized by a nocturnal periodic decrease or complete stop in airflow due to partial or total collapse of the oropharyngeal tract. Surgical treatment of OSA is constantly evolving and improving, especially with the implementation of new technologies, and this is needed because of the very heterogeneous reasons for OSA due to the multiple sites of potential airway obstruction. Moreover, all of these surgical methods have advantages and disadvantages; hence, patients should be approached individually, and surgical therapies should be chosen carefully. Furthermore, while it is well-established that oromaxillofacial surgery (OMFS) provides various surgical modalities for treating OSA both in adults and children, a new aspect is emerging regarding the possibility that some of the surgeries from the OMFS domain are also causing OSA. The latest studies are suggesting that surgical treatment in the head and neck region for causes other than OSA could possibly have a major impact on the emergence of newly developed OSA, and this issue is still very scarcely mentioned in the literature. Both oncology, traumatology, and orthognathic surgeries could be potential risk factors for developing OSA. This is an important subject, and this review will focus on both the possibilities of OMFS treatments for OSA and on the OMFS treatments for other causes that could possibly be triggering OSA.
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Affiliation(s)
- Dinko Martinovic
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Daria Tokic
- Department of Anesthesiology and Intensive Care, University Hospital of Split, 21000 Split, Croatia
| | - Ema Puizina-Mladinic
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Sanja Kadic
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Antonella Lesin
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Slaven Lupi-Ferandin
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Marko Kumric
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia
| | - Josko Bozic
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia
- Correspondence: ; Tel.: +385-21-557-871
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Shah RR, Thaler ER. Base of Tongue Surgery for Obstructive Sleep Apnea in the Era of Neurostimulation. Otolaryngol Clin North Am 2020; 53:431-443. [PMID: 32334869 DOI: 10.1016/j.otc.2020.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Retroglossal collapse is commonly seen in patients with obstructive sleep apnea. The role of upper airway stimulation surgery for these patients continues to evolve. However, base of tongue reduction surgery continues to have usefulness for appropriately selected patients with obstructive sleep apnea. Specific tongue base approaches may vary in response to patient and surgeon preferences and be used in multilevel surgery where appropriate. Key factors include patient age, willingness to undergo device implantation, and preferences for outpatient versus inpatient procedure, single procedure versus multiple, and tolerance for various procedure-specific postoperative restrictions and potential complications.
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Affiliation(s)
- Ravi R Shah
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Hospital of the University of Pennsylvania, 3400 Spruce Street, 5th Floor Silverstein Building, Philadelphia, PA 19104, USA
| | - Erica R Thaler
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Hospital of the University of Pennsylvania, 3400 Spruce Street, 5th Floor Silverstein Building, Philadelphia, PA 19104, USA.
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Guilleminault C, Hervy-Auboiron M, Huang YS, Li K, Amat P. [Obstructive sleep-disordered breathing and orthodontics. An interview with Christian Guilleminault, Michèle Hervy-Auboiron, Yu-Shu Huang and Kasey Li]. Orthod Fr 2019; 90:215-245. [PMID: 34643512 DOI: 10.1051/orthodfr/2019038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
| | | | - Yu-Shu Huang
- Department of Pediatric Psychiatry and Sleep Center, Chang Gung Memorial Hospital, No. 5, Fusing St, Kwei-Shan Township, Taoyuan Country, 333, Taiwan
| | - Kasey Li
- 1900 University Ave #105, East Palo Alto, CA 94303, États-Unis
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Kato MG, Isaac MJ, Gillespie MB, O'Rourke AK. The Incidence and Characterization of Globus Sensation, Dysphagia, and Odynophagia Following Surgery for Obstructive Sleep Apnea. J Clin Sleep Med 2018; 14:127-132. [PMID: 29198289 DOI: 10.5664/jcsm.6898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 10/11/2017] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To determine the incidence, duration, and predictors of swallowing-related symptoms following upper airway surgery for obstructive sleep apnea. METHODS Adults (age 18 years or older) who underwent surgery for obstructive sleep apnea at a tertiary care institution from January 2012 to December 2015 were retrospectively reviewed. The incidence, duration, and associated factors of postoperative swallowing complaints were evaluated. RESULTS A total of 130 patients (135 surgical encounters) met criteria for inclusion. There were 91 men (70.0%) and 39 women (30.0%) with a median age of 60 years (range: 19-79). Presurgical diagnosis of gastroesophageal reflux disease was present in 57 patients (43.8%). An average of 2.1 procedures (± 0.8) were conducted at each encounter. Uvulopalatopharyngoplasty (54.8%) was the most common followed by radiofrequency ablation of the soft palate (34.8%) and tongue base (29.6%). Postoperatively, 25 patients (19.8%) complained of dysphagia, 14 (10.9%) of globus, and 9 (6.7%) of odynophagia. Preoperative gastroesophageal reflux (odds ratio [OR] 4.09, 95% confidence interval [CI] 1.41-11.91) and hyoid myotomy with suspension (OR 4.88, 95% CI 1.34-17.77) were significant predictors for dysphagia. Radiofrequency ablation of the tongue base (OR 5.00, 95% CI 1.28-19.50) was a predictor for globus sensation. Median symptom durations, in months, were 4.0 for dysphagia, 7.3 for globus, and 3.0 for odynophagia. CONCLUSIONS Preoperative gastroesophageal reflux and hyoid myotomy with suspension procedure were associated with postoperative dysphagia whereas radiofrequency ablation of the tongue base was associated with globus. These findings can assist surgeons in providing preoperative counseling and postoperative supportive measures regarding dysphagic symptoms following sleep surgery.
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Affiliation(s)
- Masanari G Kato
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Mitchell J Isaac
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - M Boyd Gillespie
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Ashli K O'Rourke
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
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Dorrity J, Wirtz N, Froymovich O, Hamlar D. Genioglossal Advancement, Hyoid Suspension, Tongue Base Radiofrequency, and Endoscopic Partial Midline Glossectomy for Obstructive Sleep Apnea. Otolaryngol Clin North Am 2016; 49:1399-1414. [DOI: 10.1016/j.otc.2016.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Maturo SC, Mair EA. Submucosal Minimally Invasive Lingual Excision: An Effective, Novel Surgery for Pediatric Tongue Base Reduction. Ann Otol Rhinol Laryngol 2016; 115:624-30. [PMID: 16944662 DOI: 10.1177/000348940611500809] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: The aim of this study was to develop an effective single intraoral, minimally invasive technique to reduce the enlarged tongue base in children with obstructive macroglossia. Methods: We present the anatomic dissection of fresh cadavers and a representative case series of children who underwent submucosal minimally invasive lingual excision (SMILE) with a plasma-mediated radiofrequency device (coblation) under intraoral ultrasonic and endoscopic guidance. Multiple anatomic dissections determined the relative location of the hypoglossal nerve and lingual neurovascular bundle in relation to removable tongue base musculature. A pediatric case series demonstrates the straightforward SMILE technique. Results: Laboratory anatomic dissection and clinical lingual ultrasonography revealed the surgical safety borders for SMILE. The surgical safety and efficacy of SMILE is demonstrated by preoperative and postoperative clinical examinations and polysomnograms in children with obstructive macroglossia (such as Beckwith-Wiedemann and Down syndromes and tongue vascular malformation). Coblation submucosally removes excessive tongue base tissue through a small anterior tongue incision. SMILE was performed without excessive pain, bleeding, edema, infection, or tongue dysfunction. Conclusions: SMILE is an effective novel operation that incorporates coblation with ultrasonography and endoscopic guidance for children who need tongue base reduction. Anatomic dissection and clinical cases demonstrate the potential for aggressive yet relatively safe tissue removal by this minimally invasive technique. SMILE also has significant potential for adults with obstructive sleep apnea due to a large tongue base.
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Affiliation(s)
- Stephen C Maturo
- Pediatric Otolaryngology Service, Department of Otolaryngology, Wilford Hall United States Air Force Medical Center, San Antonio, Texas, USA
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Steward DL, Weaver EM, Woodson BT. Multilevel Temperature-Controlled Radiofrequency for Obstructive Sleep Apnea: Extended Follow-Up. Otolaryngol Head Neck Surg 2016; 132:630-5. [PMID: 15806059 DOI: 10.1016/j.otohns.2004.11.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE: To determine long-term effectiveness of multilevel (tongue and palate) temperature-controlled radiofrequency tissue ablation (TCRFTA) for patients with obstructive sleep apnea syndrome (OSAS). STUDY DESIGN AND SETTING: Prospective, 2-institution case series. Twenty-nine subjects with mild to moderate OSAS and who were at least 1 year from completion of multilevel TCRFTA were included, representing a subset of subjects who were enrolled in a previously published controlled trial. Exclusion criteria for this extended follow-up study included any additional treatment for OSAS after completion of TCRFTA. RESULTS: Median follow-up was 23 months. Daytime sleepiness and OSAS-related quality of life were significantly improved at extended follow-up (both P 0.001). Median reaction time testing and apnea-hypopnea index (AHI) were also significantly improved at long-term follow-up ( P = 0.03 and 0.01). Body mass index was unchanged ( P = 0.94). CONCLUSIONS: Multilevel TCRFTA treatment of mild to moderate OSAS resulted in prolonged improvement in daytime somnolence, OSAS-related quality of life, psychomotor vigilance, and AHI in this group of subjects at extended follow-up.
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Affiliation(s)
- David L Steward
- Department of Otolaryngology-Head and Neck Surgery, ML 0528, University of Cincinnati, Cincinnati, OH 45267-0528, USA.
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Omur M, Ozturan D, Elez F, Unver C, Derman S. Tongue Base Suspension Combined with UPPP in Severe OSA Patients. Otolaryngol Head Neck Surg 2016; 133:218-23. [PMID: 16087018 DOI: 10.1016/j.otohns.2005.02.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2004] [Accepted: 02/23/2005] [Indexed: 10/25/2022]
Abstract
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.
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The Role of Soft-Tissue Surgery of the Tongue in Obstructive Sleep Apnea. CURRENT OTORHINOLARYNGOLOGY REPORTS 2016. [DOI: 10.1007/s40136-016-0109-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Baba RY, Mohan A, Metta VVSR, Mador MJ. Temperature controlled radiofrequency ablation at different sites for treatment of obstructive sleep apnea syndrome: a systematic review and meta-analysis. Sleep Breath 2015; 19:891-910. [PMID: 25643764 DOI: 10.1007/s11325-015-1125-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 12/13/2014] [Accepted: 01/19/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND This study seeks to determine the efficacy of temperature controlled radiofrequency tissue ablation (TCRFTA) to alleviate symptoms of obstructive sleep apnea (OSA) and reduce polysomnographic measures of OSA in the first year post-treatment. METHODS Systematic review and meta-analysis. Two independent searches of MEDLINE, EMBASE bibliographic databases, and Evidence Based Medicine Reviews to identify publications relevant to OSA and TCRFTA. Effectiveness of TCRFTA was measured separately for application of TCRFTA at the base of tongue and soft palate, and for multilevel intervention using the respiratory disturbance index (RDI), lowest oxygen saturation (LSAT), Epworth sleepiness scale (ESS), and bed partner's rating of snoring using a visual analogue scale (VAS snoring). The most recent search was conducted in April 2013. Statistical analysis was performed using Review Manager Version 5.2 using a relative measure of effect, i.e., ratio of means (RoM). RESULTS Our initial search resulted in 29 eligible studies, and subsequently, 20 studies were included in the meta-analysis. Substantial and consistent improvement in PSG and subjective outcomes were observed post-TCRFTA in the base of tongue (BOT) and multilevel surgery groups only. Application of TCRFTA at the BOT was associated with a significant reduction in RDI (RoM 0.60, CI 0.47-0.76), ESS (RoM 0.59, CI 0.51-0.67), and VAS snoring (RoM 0.48, CI 0.37-0.62) and increase in lowest oxygen saturation (RoM 1.05, CI 1.01-1.10). Similarly, a significant reduction in RDI (RoM 0.61, CI 0.47-0.80) and ESS (RoM 0.79, CI -0.71 to 0.88) was observed after multilevel TCRFTA, but substantial heterogeneity between these studies was observed. CONCLUSION TCRFTA is clinically effective in reducing RDI levels and symptoms of sleepiness in patients with OSA syndrome when directed at the base of tongue or as a multilevel procedure.
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Affiliation(s)
- Ridhwan Y Baba
- Department of Internal Medicine, University at Buffalo, Buffalo, NY, USA
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Veer V, Yang WY, Green R, Kotecha B. Long-term safety and efficacy of radiofrequency ablation in the treatment of sleep disordered breathing: a meta-analysis. Eur Arch Otorhinolaryngol 2014; 271:2863-70. [PMID: 24510179 DOI: 10.1007/s00405-014-2909-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 01/22/2014] [Indexed: 01/10/2023]
Abstract
Radiofrequency ablation (RFA) is used in the treatment of sleep disordered breathing (SDB), particularly in the alleviation of snoring. The literature provides evidence that the short-term results are promising; however, the long-term efficacy is a matter of contention. In this article, we present the results of a literature search of studies that use RFA in the treatment of SDB which have a follow-up time of greater than a year. RFA was found to be a safe technique with minimal morbidity. The overall Visual Analogue score from six studies showed the overall mean improvement to be 4.3 (confidence intervals 3.4-5.12). Apnea Hypopnea Index (AHI), improved significantly in five of the studies analysed. Epworth Sleepiness Score (ESS), improved significantly in six of the studies analysed. In conclusion, the evidence suggests that RFA for SDB results in a significant improvement in follow-up times of at least a year. Since RFA can be applied in a clinic setting and leads to minimal disruption to daily life, this treatment option can be considered for those unwilling to participate in the more traditional surgical options for SDB.
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Affiliation(s)
- Vik Veer
- James Cook University Hospital, Middlesbrough, England,
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Hou TN, Shao J, Wang G, Ren H, Cheng B. Analysis of the dynamic relationships between the lingual artery and lingual markers in patients with obstructive sleep apnea. Surg Radiol Anat 2013; 35:553-7. [PMID: 23344630 DOI: 10.1007/s00276-013-1074-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Accepted: 01/05/2013] [Indexed: 12/25/2022]
Abstract
PURPOSE To determine the relationships between the lingual artery and the lingual markers in tongue resting and extended positions in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) for the clinical application of functional tongue surgery. METHOD Computed tomography angiography (CTA) of the lingual artery was performed on 30 OSAHS patients using a 16-slice spiral CT scanner. The anatomical relationships between the lingual artery and the lingual markers were analyzed with the tongue in resting and extended positions using the CTA images. RESULTS The course of the lingual artery resembled the configuration of the Big Dipper constellation when the tongue was in a resting position. When the tongue was in a full-extended position, the majority of the lingual artery moved forward and upward with the hyoid and formed a "√" fashion. The positions of the tip of the greater horn of the hyoid changed with the tongue positions. While the relationship between the main lingual artery and the tip of the greater horn of the hyoid, as well as the distances between bilateral lingual arteries, remained constant in both tongue positions. CONCLUSIONS In conditions of dynamic tongue movement, the tip of the great horn of the hyoid and the lingual midline are constant anatomical markers to indicate the course of the lingual artery.
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Affiliation(s)
- Tie-ning Hou
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Sir Run Run Shaw Hospital, Medical College, Zhejiang University, 3 Qinchun East Road, Hangzhou, China
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Hou T, Hu S, Jiang X. Tongue coblation via the ventral approach for obstructive sleep apnea-hypopnea syndrome surgery. Laryngoscope 2012; 122:2582-6. [PMID: 22965646 DOI: 10.1002/lary.23556] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 04/27/2012] [Accepted: 06/11/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine the safety and efficacy of tongue Coblation via the ventral approach in the treatment of hypopharyngeal obstruction for patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). STUDY DESIGN Prospective case-control study. METHODS Tongue Coblation was performed under local anesthesia in one session in 40 inpatients diagnosed with OSAHS with predominant hypopharyngeal obstruction after failed uvulopalatopharyngoplasty. In the ventral approach (n = 20), only one puncture point was applied at the center of lingual frenulum, and 12 radiofrequency volumetric tissue reduction (RFVTR) lesions were implanted in the tongue. In the dorsal approach (n = 20), eight RFVTR lesions were distributed on the tongue. Using portable polysomnography (PSG) and the Epworth sleepiness questionnaire (ESQ), we followed 36 patients for 1 year after the operation. Good outcome was defined as apnea-hypopnea index <20 or reduction >50%. RESULTS In the ventral approach, total energy was accumulated to 23,000 J in 12 lesions, with postoperative pain 2-3 by visual analog scale (VAS). There was only one case of moderate venous bleeding and hematoma. The ESQ comparison indicated subjective improvements in patients, and PSG showed a curative effect in 11 of 19 (61.11%, eight of 19 success plus three of 19 responders), with a failure rate of eight of 19. By contrast, in the dorsal approach, total energy was 16,000 J, with postoperative pain 3-4 (VAS). Complications included mild to moderate tongue venous hematoma, severe infection of tongue, and temporary mild glossal deviation. A curative effect was seen in six of 17, with a failure rate of 11 of 17. CONCLUSIONS Tongue Coblation via the ventral approach is an effective and safe technique to treat hypopharyngeal obstruction in OSAHS surgery.
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Affiliation(s)
- Tiening Hou
- Department of Otolaryngology-Head and Neck Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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15
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Jafari B, Roux F. Non-positive airway pressure therapy for obstructive sleep apnea. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s13665-012-0016-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Verse T, Hörmann K. The surgical treatment of sleep-related upper airway obstruction. DEUTSCHES ARZTEBLATT INTERNATIONAL 2011; 108:216-21. [PMID: 21505609 DOI: 10.3238/arztebl.2010.0216] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Accepted: 04/27/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a very common disorder among adults: the prevalence of mild OSA is 20%, and that of moderate or severe OSA is 6% to 7%. Simple snoring is even more common. Conservative treatments such as nocturnal ventilation therapy and oral appliances are successful as long as the patient actually uses them, but they do not eliminate the underlying obstruction of the upper airway. METHOD The relevant literature up to 2008 on the surgical treatment of OSA was selectively reviewed. RESULTS Five types of surgical treatment for OSA are available, each for its own indications: optimization of the nasal airway to support nasal ventilation therapy, (adeno-)tonsillectomy as first-line treatment for OSA in children, minimally invasive surgery for simple snoring and mild OSA, invasive surgery as first- and second-line treatment for mild OSA, and invasive multilevel surgery as second-line treatment of moderate to severe OSA that remains refractory to ventilation therapy. CONCLUSION Surgical treatment for OSA is appropriate for specific indications as a complement to the established conservative treatment methods.
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Affiliation(s)
- Thomas Verse
- Abteilung für HNO-Heilkunde, Kopf- und Halschirurgie, Asklepios Klinik Harburg, Eißendorfer Pferdeweg 52, D-21075 Hamburg
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Vicini C, Dallan I, Canzi P, Frassineti S, Nacci A, Seccia V, Panicucci E, Grazia La Pietra M, Montevecchi F, Tschabitscher M. Transoral robotic surgery of the tongue base in obstructive sleep Apnea-Hypopnea syndrome: Anatomic considerations and clinical experience. Head Neck 2011; 34:15-22. [DOI: 10.1002/hed.21691] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2010] [Revised: 09/11/2010] [Accepted: 10/22/2010] [Indexed: 11/09/2022] Open
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Abstract
PURPOSE OF REVIEW Patients with obstructive sleep apnea (OSA), as well as their physicians, seek alternative therapies to continuous positive airway pressure (CPAP) due to problems with CPAP adherence. A large variety of surgical options exist, and each intervention must be individually evaluated. The author performed a literature search concerning surgery for sleep apnea until May 2010. The studies were evaluated according to evidence-based medicine criteria. RECENT FINDINGS An increasing number of controlled and even randomized controlled trials are available. Minimally invasive surgery remains under debate due to the very limited efficacy versus very low morbidity. Uvulopalatopharyngoplasty is still the standard procedure for many patients with moderate OSA, whereas maxillomandibular advancement is as effective as CPAP in severe OSA. Multilevel surgery is reserved to secondary treatment after CPAP failure. Tonsillectomy and maxillomandibular advancement may be offered as a first-line treatment in certain patients. There is increasing evidence that upper airway surgery has a positive impact on arterial hypertension, markers of cardiovascular disease, insomnia, daytime symptoms, quality of life, and CPAP adherence. SUMMARY Patients who are nonadherent to CPAP must be thoroughly evaluated before choosing any of the available surgical options. Upper airway surgery may improve disease markers of OSA, if appropriately chosen and properly indicated and performed.
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Madani M, Madani FM, Peysakhov D. Reoperative treatment of obstructive sleep apnea. Oral Maxillofac Surg Clin North Am 2010; 23:177-87, viii. [PMID: 21126881 DOI: 10.1016/j.coms.2010.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Over the last several decades, various surgical treatments have been advocated and used to treat obstructive sleep apnea. Treatments ranging from aggressive procedures, such as tracheostomy, to the least-invasive procedures, such as radioablation, have not yielded satisfactory results. One of the major causes for surgical failures and lower success rates lies in the inadequate understanding and appreciation of the anatomic and pathophysiologic factors that contribute to upper airway obstruction. In some cases, combinations of various surgical techniques may help improve the conditions. This article reviews several major types of surgical procedures, their complications, and the recommended approaches for retreatments.
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Affiliation(s)
- Mansoor Madani
- Department of Oral and Maxillofacial Surgery, Capital Health Regional Medical Center, Trenton, NJ 08638, USA.
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Tanyeri HM, Polat S. Temperature-controlled radiofrequency tonsil ablation for the treatment of halitosis. Eur Arch Otorhinolaryngol 2010; 268:267-72. [DOI: 10.1007/s00405-010-1356-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2010] [Accepted: 07/25/2010] [Indexed: 10/19/2022]
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Abstract
Obstructive sleep apnea (OSA) is a prevalent condition characterized by repetitive airway obstruction during sleep with associated increased morbidity and mortality. Although CPAP is the preferred treatment, poor compliance is common. Patients intolerant of conventional OSA medical treatment may benefit from surgical therapy to alleviate pharyngeal obstruction. Case series suggest that maxillomandibular advancement has the highest surgical efficacy (86%) and cure rate (43%). Soft palate surgical techniques are less successful, with uvulopalatopharyngoplasty having an OSA surgical success rate of 50% and cure rate of 16%. Further research is needed to more thoroughly assess clinical outcomes (eg, quality of life, morbidity), better identify key preoperative patient and clinical characteristics that predict success, and confirm long-term effectiveness of surgical modalities to treat OSA.
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Randerath WJ. Alternatives to positive airway pressure for obstructive sleep apnea syndrome. Expert Rev Respir Med 2010; 3:255-63. [PMID: 20477320 DOI: 10.1586/ers.09.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Owing to the prevalence, the considerable risk of accidents and cardiovascular consequences, optimal treatment of obstructive sleep apnea syndrome is of crucial importance. However, many patients look for alternative conservative or surgical therapies to continuous positive airway pressure to avoid discomfort and local side-effects owing to the mask. Scientific data are lacking for most of the alternative methods. However, it has been proven that intra-oral appliances can reduce mild-to-moderate respiratory disturbances; the maxillo-mandibular osteotomy is efficient in the short- and long-term but is preferred in special situations such as craniofacial dysmorphias. Weight reduction and body positioning cannot be recommended as a single treatment for obstructive sleep apnea syndrome. Resections of muscular tissue within the soft palate have to be strictly avoided. Efficacy of gentle soft palate procedures is difficult to predict and often decreases in the years following this treatment. Multilevel surgery concepts are of increasing interest, although more data from prospective, controlled studies are needed.
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Affiliation(s)
- Winfried J Randerath
- Professor of Medicine, Institute of Pneumology at the University Witten/Herdecke, Clinic for Pneumology & Allergology, Center of Sleep Medicine & Respiratory Care, Bethanien Hospital, Aufderhöherstrasse 169-175, 42699 Solingen, Germany.
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Abstract
The current guideline discusses conservative and surgical therapy of obstructive sleep apnea (OSA) in adults from the perspective of the ear, nose and throat specialist. The revised guideline was commissioned by the German Society of Ear-Nose-Throat, Head-Neck Surgery (DG HNO KHC) and compiled by the DG HNO KHC's Working Group on Sleep Medicine. The guideline was based on a formal consensus procedure according to the guidelines set out by the German Association of Scientific Medical Societies (AWMF) in the form of a"S2e guideline". Research of the literature available on the subject up to and including December 2008 forms the basis for the recommendations. Evaluation of the publications found was made according to the recommendations of the Oxford Centre for Evidence-Based Medicine (OCEBM). This yielded a recommendation grade, whereby grade A represents highly evidence-based studies and grade D those with a low evidence base.
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Neruntarat C, Chantapant S. Radiofrequency Surgery for the Treatment of Obstructive Sleep Apnea: Short-Term and Long-Term Results. Otolaryngol Head Neck Surg 2009; 141:722-6. [DOI: 10.1016/j.otohns.2009.09.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 09/20/2009] [Accepted: 09/29/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVE: To compare the short-term and long-term results in patients undergoing radiofrequency (RF) for obstructive sleep apnea (OSA). STUDY DESIGN: Case series and planned data collection. SETTING: Tertiary referral center. SUBJECTS AND METHODS: A study was undertaken on 72 OSA patients with palatal and tongue base obstruction based on radiography and physical findings. Multilevel RF was conducted to reduce the tissue. RESULTS: Patients had a mean age of 35.8 ± 10.9 years and a mean body mass index (BMI) of 28.8 ± 2.4 kg/m 2 . The mean follow-up was 14.2 ± 1.8 months, with arange of 12 to 16 months. Mean baseline apnea-hypopnea index (AHI), short-term AHI, and long-term AHI were 35.6 ± 9.2, 12.5 ± 4.8, and 16.8 ± 3.2, respectively. Mean baseline lowest oxygen saturation (LSAT), short-term LSAT, and long-term LSAT were 85.6 ±3.4 percent, 88.7 ± 2.9 percent, and 88.2 ±1.7 percent, respectively. The change in BMI was significantly different in the patients with and without recurrence (2.8 ± 1.8 vs 0.3 ± 0.2 kg/m 2 , P < 0.01). Forty (55.6%) patients had long-term success, and eight (16.7%) patients with short-term success failed in the long term. Serious complications were not encountered. CONCLUSION: RF is a minimally invasive and effective procedure that results in long-term success for patients with a relatively low BMI and mild to moderate OSA without nasal obstruction. However, a recommendation concerning weight control and a regular follow-up are important because some patients will relapse in the long term.
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Affiliation(s)
- Chairat Neruntarat
- Department of Otolaryngology, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
| | - Suprapol Chantapant
- Department of Otolaryngology, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
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Fibbi A, Ameli F, Brocchetti F, Mignosi S, Cabano ME, Semino L. Tongue base suspension and radiofrequency volume reduction: a comparison between 2 techniques for the treatment of sleep-disordered breathing. Am J Otolaryngol 2009; 30:401-6. [PMID: 19880029 DOI: 10.1016/j.amjoto.2008.08.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Accepted: 08/03/2008] [Indexed: 11/26/2022]
Abstract
PURPOSE Lingual suspension (LS) and tongue base radio frequency volume reduction (RFVR) have been proposed as means of correcting the obstruction caused by the collapse or hypertrophy of the tongue base in patients having sleep-disordered breathing (SDB). The aim of this study was to evaluate and compare long-term results (6 months and 2 years) in a population of 24 patients having mild obstructive sleep apnea syndrome (OSAS), of whom 12 were treated with LS and 12 with RFVR. MATERIALS AND METHODS The study included 24 patients having mild OSAS (apnea-hypopnea index between 10 and 20). All patients were assessed by means of the Epworth Sleepiness Scale, collection of anthropomorphic data, fiber-optic evaluation with Muller's maneuver, cephalometric assessment, and polysomnography. Lingual suspension was performed under general anesthesia with cervical cutaneous access. Radio frequency volume reduction was performed under local anesthesia with an Ellman Surgitron Dual RF unit (Ellman International, Inc., New York, NY), using a resterilizable bipolar terminal prototype. The same ear, nose, and throat examinations and polysomnography were carried out 6 months and 2 years after the surgical procedure. RESULTS The results were evaluated according to the criteria by Sher (Sleep. 1996,19:156-177); after 6 months, the success percentage was 67% in patients treated with LS and 75% in those with RFVR. These percentages dropped to 42% in the first group and 33% in the second group after 24 months. CONCLUSIONS Lingual suspension and RFVR are simple procedures that can be quickly performed and are well tolerated by patients. However, their effectiveness drops after 2 years. Our experience has therefore led us to conclude that the minimally invasive treatment for tongue base surgery can guarantee long-term results only in 42% and 33% of patients, respectively. Moreover, RFVR is preferable because it is simpler to perform and less invasive than LS, and it can be repeated over time.
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Contemporary surgery for obstructive sleep apnea syndrome. Clin Exp Otorhinolaryngol 2009; 2:107-14. [PMID: 19784401 PMCID: PMC2751873 DOI: 10.3342/ceo.2009.2.3.107] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2009] [Accepted: 08/16/2009] [Indexed: 11/08/2022] Open
Abstract
Surgical treatment of obstructive sleep apnea syndrome (OSAS) has been available in some form for greater than three decades. Early management for airway obstruction during sleep relied on tracheotomy which although life saving was not well accepted by patients. In the early eighties two new forms of treatment for OSAS were developed. Surgically a technique described as a uvulopalatopharyngoplasty (UPPP) was used to treat the retropalatal region for snoring and sleep apnea. Concurrently sleep medicine developed a nasal continuous positive airway pressure (CPAP) device to manage nocturnal airway obstruction. Both of these measures were used to expand and stabilize the pharyngeal airway space during sleep. The goal for each technique was to limit or alleviate OSAS. Almost 30 yr later these two treatment modalities continue to be the mainstay of contemporary treatment. As expected, CPAP device technology improved over time along with durable goods. Surgery followed suit and additional techniques were developed to treat soft and bony structures of the entire upper airway (nose, palate and tongue base). This review will only focus on the contemporary surgical methods that have demonstrated relatively consistent positive clinical outcomes. Not all surgical and medical treatment modalities are successful or even partially successful for every patient. Advances in the treatment of OSAS are hindered by the fact that the primary etiology is still unknown. However, both medicine and surgery continue to improve diagnostic and treatment methods. Methods of diagnosis as well as treatment regimens should always include both medical and surgical collaborations so the health and quality of life of our patients can best be served.
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Farrar J, Ryan J, Oliver E, Gillespie MB. Radiofrequency Ablation for the Treatment of Obstructive Sleep Apnea: A Meta-analysis. Laryngoscope 2008; 118:1878-83. [DOI: 10.1097/mlg.0b013e31817d9cc1] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Shcherbatyy V, Perkins JA, Liu ZJ. Internal kinematics of the tongue following volume reduction. Anat Rec (Hoboken) 2008; 291:886-93. [PMID: 18484603 DOI: 10.1002/ar.20699] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study was undertaken to determine the functional consequences following tongue volume reduction on tongue internal kinematics during mastication and neuromuscular stimulation in a pig model. Six ultrasonic-crystals were implanted into the tongue body in a wedge-shaped configuration which allows recording distance changes in the bilateral length (LENG) and posterior thickness (THICK), as well as anterior (AW), posterior dorsal (PDW), and ventral (PVW) widths in 12 Yucatan-minipigs. Six animals received a uniform mid-sagittal tongue volume reduction surgery (reduction), and the other six had identical incisions without tissue removal (sham). The initial-distances among each crystal-pairs were recorded before, and immediately after surgery to calculate the dimensional losses. Referring to the initial-distance there were 3-66% and 1-4% tongue dimensional losses by the reduction and sham surgeries, respectively. The largest deformation in sham animals during mastication was in AW, significantly larger than LENG, PDW, PVW, and THICK (P < 0.01-0.001). In reduction animals, however, these deformational changes significantly diminished and enhanced in the anterior and posterior tongue, respectively (P < 0.05-0.001). In both groups, neuromuscular stimulation produced deformational ranges that were 2-4 times smaller than those occurred during chewing. Furthermore, reduction animals showed significantly decreased ranges of deformation in PVW, LENG, and THICK (P < 0.05-0.01). These results indicate that tongue volume reduction alters the tongue internal kinematics, and the dimensional losses in the anterior tongue caused by volume reduction can be compensated by increased deformations in the posterior tongue during mastication. This compensatory effect, however, diminishes during stimulation of the hypoglossal nerve and individual tongue muscles.
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Affiliation(s)
- Volodymyr Shcherbatyy
- Department of Orthodontics, University of Washington, Seattle, Washington 98195-3446, USA
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30
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Sleep apnea (central and obstructive). Sleep Med 2008. [DOI: 10.1017/cbo9780511545085.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
Obstructive sleep apnea (OSA) is the result of upper airway obstruction during sleep. Hypopharyngeal airway obstruction can be caused by the prominence or relaxation of the base of the tongue, lateral pharyngeal wall, and occasionally, the aryepiglottic folds or epiglottis. Although nasal continuous positive airway pressure (CPAP) is considered as the first treatment for obstructive sleep apnea, surgery has been shown to be a viable option for patients who are intolerant of positive pressure therapy. This article presents the current state of hypopharyngeal surgery for sleep apnea. Preoperative airway evaluation with fiberoptic nasopharyngoscopy, the use of lateral cephalometric radiograph, and the formulation of a surgical plan with selection of procedures to address hypopharyngeal obstruction are discussed.
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Affiliation(s)
- Kasey K Li
- Stanford Sleep Disorders Clinic and Research Center, 401 Quarry Road, Stanford, CA 94305, USA.
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Ephros HD, Madani M, Geller BM, Defalco RJ. Developing a protocol for the surgical management of snoring and obstructive sleep apnea. Atlas Oral Maxillofac Surg Clin North Am 2007; 15:89-100. [PMID: 17823070 DOI: 10.1016/j.cxom.2007.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Affiliation(s)
- Hillel D Ephros
- Department of Oral and Maxillofacial Surgery, St. Joseph's Hospital and Medical Center, 703 Main St, Paterson, NJ 07503, USA.
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Welt S, Maurer JT, Hörmann K, Stuck BA. Radiofrequency surgery of the tongue base in the treatment of snoring—a pilot study. Sleep Breath 2006; 11:39-43. [PMID: 17115226 DOI: 10.1007/s11325-006-0080-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In a previously published study, a significant reduction of snoring was reported after treatment with radiofrequency surgery of the tongue base in patients suffering from obstructive sleep apnea syndrome. The aim of this study was to investigate the efficacy of radiofrequency surgery of the tongue base in the treatment of primary snoring. Twenty patients suffering from primary snoring (AHI < 10/h, body mass index < 32 kg/m(2)) and an isolated hypertrophic tongue base at clinical examination were enrolled in this clinical trial. The patients underwent bipolar radiofrequency surgery of the tongue base under local anaesthesia. Pre- and post-operative body weight, daytime sleepiness (Epworth sleepiness scale) and snoring scores (visual analogue scales) were evaluated by the patients and their bed partners, respectively. Postoperative follow-up data was collected 6-8 weeks after treatment. A statistically significant reduction of the preoperative snoring levels from 7.5 +/- 2.4 to 6.1 +/- 2.8 was seen after treatment (p < 0.001). Body weight and daytime sleepiness remained unaffected. Only 3 out of 20 patients were satisfied with the result as defined by VAS < 3. Despite statistically significant reduction of the subjective snoring scores after radiofrequency of the tongue base, only minimal clinical improvement was achieved. Only 3 out of 20 patients were satisfied with the results. With regard to the clearly beneficial effect seen in patients with obstructive sleep apnea, this result indicates different pathophysiological principles in the generation of snoring.
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Affiliation(s)
- Sandra Welt
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, 68135, Mannheim, Germany.
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Blumen MB, Coquille F, Rocchicioli C, Mellot F, Chabolle F. Radiofrequency Tongue Reduction Through a Cervical Approach: A Pilot Study. Laryngoscope 2006; 116:1887-93. [PMID: 17003707 DOI: 10.1097/01.mlg.0000234935.25098.32] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE/HYPOTHESIS The objective of this prospective cohort study was to determine the feasibility, safety, and efficacy of radiofrequency tongue base reduction through a cervical approach in patients with obstructive sleep apnea syndrome (OSAS). METHODS Patients with moderate to severe OSAS and predominant tongue base obstruction by physical examination were included at our institution from 1999 to 2003. A sonogram was obtained to identify the lingual arteries, and an electrode was inserted through the neck and into the tongue under fluoroscopic guidance. Adverse events were recorded as well as efficacy on snoring (visual analog scale), daytime sleepiness (Epworth score), and polysomnography. RESULTS The 10 patients received a mean of 14,288 +/- 3,251 J per session. No cases of tongue palsy or infection occurred. During the first 7 days, mean pain score (0-10 scale) was 1.3 +/- 1.5. Snoring volume (0-10 scale) decreased from 6.2 +/- 2.3 to 3.9 +/- 2.6 (P = .017) and sleepiness (0-24 scale) from 8.7 +/- 5.6 to 4.7 +/- 3.3 (P = .011). The respiratory disturbance index (events/hour) decreased from 52.0 +/- 19.6 to 33.6 +/- 24.4 (P = .016). Mean minimal oxygen saturation (%) increased from 64.2 +/- 13.0 to 75.8 +/- 10.3 (P = .003). Sleep architecture improved although not significantly. CONCLUSION Radiofrequency tongue base reduction through a cervical approach proved feasible and safe despite the large energy doses used. Fluoroscopic guidance enables to place the electrode at the desired site of treatment. Although OSAS improved in nine of 10 patients, greater efficacy might be achieved in patients with less severe OSAS at baseline. Studies are needed to correlate objective clinical efficacy with the dose per lesion site and the number of lesion sites per session.
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Affiliation(s)
- Marc B Blumen
- ENT and Cervico Facial Department, Foch Hospital, Suresnes, France.
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Abstract
Obstructive sleep apnea (OSA) is a highly significant condition based both on the high prevalence in community and significant consequences. Obstructive sleep apnea syndrome (OSAS), OSA together with hypersomnolence, is seen in 4% of middle-aged men and 2% of middle-aged women. OSA is associated with impaired quality of life and increased risks of motor vehicle accidents, cardiovascular disease (including hypertension and coronary artery disease), and metabolic syndrome. There is some evidence for the use of conservative interventions such as weight loss and position modification. CPAP remains the mainstay of treatment in this condition with high-level evidence supporting its efficacy. Continuous positive airway pressure (CPAP) is an intrusive therapy, with long-term adherence rates of less than 70%. Dental appliances have been shown to be effective therapy in some subjects but are limited by the inability to predict treatment responders. Alternative treatments are discussed but there is little role for upper airway surgery (except in a select few experienced institutions) or pharmacological treatment. The current levels of evidence for the different treatment regimens are reviewed.
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Affiliation(s)
- Craig A Hukins
- Sleep Disorders Centre, Department of Respiratory and Sleep Medicine, Princess Alexandra Hospital, Woolloongabba, Australia.
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den Herder C, Kox D, van Tinteren H, de Vries N. Bipolar radiofrequency induced thermotherapy of the tongue base: Its complications, acceptance and effectiveness under local anesthesia. Eur Arch Otorhinolaryngol 2006; 263:1031-40. [PMID: 16862445 DOI: 10.1007/s00405-006-0115-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2005] [Accepted: 05/31/2006] [Indexed: 11/29/2022]
Abstract
We assessed adverse events and complications of bipolar radiofrequency induced thermotherapy of the tongue base (RFTB) in patients with socially unacceptable snoring (SUS) or obstructive sleep apnea syndrome (OSAS) and determine its acceptance and effectiveness when conducted under local anesthesia. This investigation consisted of (1) a prospective, open-enrollment study of 24 consecutive patients with snoring and OSAS at the tongue base level only (Fujita III), assessed by sleep endoscopy. Polysomnography, questionnaires, and visual analog scales (VAS) were used to assess outcome. (2) In addition, a retrospective review of 83 patients, who underwent RFTB (in 59 cases as part of a multilevel treatment), was performed to evaluate adverse events and complications. Twenty-two of the 24 patients completed postoperative questionnaires and VAS, and ten patients had postoperative polysomnography. Reduction in snoring (P = 0.0003), hypersomnolence (P = 0.002), and globus (P = 0.031) was significant. A positive trend in AHI (P = 0.001, n = 3) is shown in patients with moderate to severe OSAS. Concerning postoperative adverse events and complications, only two patients had a mild and transient tongue deviation directly after the procedure, which resolved within an hour postoperatively (adverse event rate 1.8%). No postoperative complications such as infections, abscesses, hematomas, or ulcerations of the tongue base occurred. This study demonstrates that bipolar RFTB in patients with obstruction at the tongue base only (Fujita type III) as visualized by sleep endoscopy is a safe and simple procedure under local anesthesia and can be effective in patients with SUS. No complications during this study were observed. Its effect on OSAS has been shown by other authors, although long-term effects are not stable. The RFTB can be considered as first choice treatment in case of snoring and mild OSAS in Fujita type III obstruction. In the case of moderate to severe sleep apnea, RFTB can be considered as an additional treatment.
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Affiliation(s)
- Cindy den Herder
- Department of Otolaryngology/Head and Neck Surgery, St Lucas Andreas Hospital, Amsterdam, The Netherlands.
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Randerath W, Bauer M, Blau A, Fietze I, Galetke W, Hein H, Maurer JT, Orth M, Rasche K, Ruhle KH, Sanner B, Stuck BA, Verse T. Stellenwert der Nicht-nCPAP-Verfahren in der Therapie des obstruktiven Schlafapnoe-Syndroms. Relevance of Non-CPAP Treatment Options in the Therapy of the Obstructive Sleep Apnoea Syndrome. SOMNOLOGIE 2006. [DOI: 10.1111/j.1439-054x.2006.00082.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Stellenwert der Nicht-nCPAP-Verfahren in der Therapie des obstruktiven Schlafapnoe-Syndroms. SOMNOLOGIE 2006. [DOI: 10.1007/j.1439-054x.2006.00082.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Baujat B, Krastinova-Lolov D, Blumen M, Baglin AC, Coquille F, Chabolle F. Radiofrequency in the Treatment of Craniofacial Plexiform Neurofibromatosis: A Pilot Study. Plast Reconstr Surg 2006; 117:1261-8. [PMID: 16582798 DOI: 10.1097/01.prs.0000204863.40195.dd] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neurofibromatosis type 1 manifests itself by the development of plexiform neurofibromas, with craniofacial deformities caused by bone alterations and soft-tissue infiltration. The medical treatment of this disease is disappointing, and the surgical management of these deformities calls for aggressive procedures. There is a strong risk of recurrence. METHODS A pilot study was performed to test radiofrequency as a minimally invasive method with which to diminish the size of craniofacial neurofibromas either as an adjunct to craniofacial surgery (in cranio-orbital neurofibromas) or to avoid a visible scar in young patients (in infraorbital neurofibromas). Five patients ranging in age from 6 to 18 years were treated by three procedures 2 months apart using radiofrequency performed under local anesthesia or under sedation for the youngest patients. RESULTS The tolerance of the treatment was excellent, with no major side effects and no pain in the postoperative course. A diminution of the size of the lesion was noted clinically in four patients and on computed tomography in two patients. A biopsy performed in one case illustrated the effect of the treatment. CONCLUSIONS A partial diminution or stabilization of plexiform neurofibromas may be obtained using radiofrequency. This treatment is well tolerated. The best effect can be observed in the early stages of the disease. The optimal dose and frequency of the procedure require further study.
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Affiliation(s)
- Bertr Baujat
- Department of Head and Neck Surgery, Hôpital Foch, Suresnes, France.
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40
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Abstract
THE PRIMARY TREATMENT for obstructive sleep apnea (OSA) has been continuous positive airway pressure (CPAP) therapy, but the minimum acceptable number of hours of nightly CPAP use remains unclear. INTEGRATED SOFT TISSUE and bone surgery may be a viable alternative for patients who have rejected CPAP as a treatment option. Formal sleep testing has shown that surgery and CPAP therapy are equally successful at resolving OSA. REPEAT SLEEP TESTING conducted several years after patients have undergone combined soft tissue and bone surgery has demonstrated consistent and reliable surgical results. Patients with OSA should be offered surgery as an alternative to life-long CPAP treatment or as an option when CPAP therapy has not been successful.
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41
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Abstract
The bipolar scissors, coblator, harmonic scalpel, and somnoplasty techniques are widely available and offer new choices for the operating arena. There are advantages and disadvantages to all four techniques. With time, these dissection methods will prove their lasting power. Otolaryngologists have already begun to expand their applications and will surely play a role in their use and development.
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Affiliation(s)
- Thomas Carroll
- Department of Otolaryngology, University of Colorado Health Sciences Center, 4200 East Ninth Avenue, B 205, Denver, CO 80262, USA.
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Abstract
Despite advances in positive pressure therapy for obstructive sleep apnea, compliance continues to be a problem for many patients. Sleep apnea surgery is a viable option for patients who are intolerant of positive pressure therapy. This review will present the current state of art in sleep apnea surgery, including airway evaluation with fiberoptic nasopharyngoscopy and lateral cephalometric radiograph, formulation of a surgical plan through a selection of procedures to address specific sites of obstruction, as well as discussion of published surgical outcomes.
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Affiliation(s)
- Kasey K Li
- Stanford Sleep Disorders Clinic and Research Center, 1900 University Avenue, Suite 105, East Palo Alto, CA 94303, USA.
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Steward DL. Effectiveness of multilevel (tongue and palate) radiofrequency tissue ablation for patients with obstructive sleep apnea syndrome. Laryngoscope 2005; 114:2073-84. [PMID: 15564825 DOI: 10.1097/01.mlg.0000149438.35855.af] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- David L Steward
- Department of Otolaryngology-Head and Neck Surgery and The Neuroscience Institute, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267, U.S.A.
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Abstract
Obstructive sleep apnea is a highly prevalent disorder that significantly increases mortality when it is moderate to severe. Continuous positive airway pressure (CPAP) provides excellent relief to sleep apnea in the majority of patients. Unfortunately, many patients cannot tolerate CPAP and seek surgical alternatives. The reported surgical success rates range between 25 and 100% with most studies achieving a 50-70% success rate. The severity of the sleep apnea, as well as the patient's physical features influence the surgical success rate. Patients with mild sleep apnea should be treated if systematic. Treatment should be encouraged for patients with moderate to severe sleep apnea because of the decrease in life expectancy and other associated morbidities. Current surgical procedures include uvulopalatopharyngoplasty, genioglossus advancement, radiofrequency ablation to the base of tongue, tongue suspension, maxillomandibular advancement, and tracheostomy.
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Affiliation(s)
- Craig W Senders
- Department of Otolaryngology, UC Davis Medical Center, Sacramento, CA, USA.
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Woodson BT, Steward DL, Weaver EM, Javaheri S. A Randomized Trial of Temperature-Controlled Radiofrequency, Continuous Positive Airway Pressure, and Placebo for Obstructive Sleep Apnea Syndrome. Otolaryngol Head Neck Surg 2003; 128:848-61. [PMID: 12825037 DOI: 10.1016/s0194-59980300461-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE: The study goal was to determine the effectiveness of (1) multilevel temperature-controlled radiofrequency tissue ablation (TCRFTA) or (2) continuous positive airway pressure (CPAP) for the treatment of mild to moderate obstructive sleep apnea syndrome (OSAS).
STUDY DESIGN AND METHODS: We conducted a randomized, placebo-controlled, 2-site trial, comparing TCRFTA (n=30) and CPAP (n=30) with sham-placebo (n=30) using intention-to-treat analysis.
RESULTS: Compared with pretreatment baseline, TCRFTA improved reaction time, OSAS-specific quality of life (QOL), and subjective sleepiness (all P < 0.05). Compared with sham-placebo, TCRFTA improved QOL, airway volume, apnea index, and respiratory arousal index (all P < 0.05). TCRFTA side effects and complications were mild, temporary, and similar to sham-placebo. CPAP improved QOL and sleepiness compared with baseline and QOL when compared with sham-placebo (all P < 0.05). Significant differences were not seen between TCRFTA and CPAP outcomes.
CONCLUSION: TCRFTA and CPAP each improve QOL for mild-moderate OSAS patients. TCRFTA improvements may result from changes in airway volume, apnea index, and respiratory arousal index.
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Affiliation(s)
- B Tucker Woodson
- Department of Otoraryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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Abstract
Since the first description of sleep apnea as a clinical entity, the understanding of it within the medical community has increased significantly. Much research has explored the causes, assessment, and treatment of this disease. This research has resulted in a variety of tools for assessment and approaches to treatment. As research progresses, new data have shed light on the strengths of traditional approaches and their limitations. This article gives background for current approaches and charts a potential future course for sleep apnea assessment and treatment.
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Affiliation(s)
- K Christopher McMains
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, 1120 Fifteenth Street, Augusta, GA 30912-4060, USA
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