1
|
Kattimani V, Panneerselvam E, Tiwari R, Panga GSK, Sreeram RR. An Overview of Systematic Reviews on the Surgical Management of Obstructive Sleep Apnoea. J Maxillofac Oral Surg 2023; 22:781-793. [PMID: 38105854 PMCID: PMC10719205 DOI: 10.1007/s12663-023-02051-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/21/2023] [Indexed: 12/19/2023] Open
Abstract
Background Obstructive Sleep Apnoea (OSA) is a common sleep disorder marked by partial or total obstruction of the upper airway while a person is asleep leading to breathing difficulty, reduced oxygenation and frequent awakenings. This condition affects the general health significantly compromising quality of life. The objective of this overview is to thoroughly assess the systematic reviews on current surgical therapies for the management of OSA in terms of patient outcomes. Methods A thorough literature search was performed from inception till 31st December 2022 using PubMed, and Cochrane databases. Studies evaluating the effectiveness and safety of different surgical techniques for the management of OSA were considered. The quality of articles was assessed using AMSTAR (A MeaSurement Tool to Assess systematic Reviews) and Glenny et al. checklist. Results Out of eighteen studies, only seven studies met the inclusion and exclusion criteria. Results showed that the majority of studies were in the pediatric age group except one systematic review which assessed the adult age group. Conclusion None of the published articles had compared all surgical procedures based on the standard evaluating procedure nor followed all reporting guidelines in the primary studies. For better implementation, further multi center studies are warranted with unique reporting criteria and guidelines about pre- as well as post-operative phases. Future research should concentrate on contrasting strategies, combination therapies, and evaluating long-term effects. Supplementary Information The online version contains supplementary material available at 10.1007/s12663-023-02051-x.
Collapse
Affiliation(s)
- Vivekanand Kattimani
- SIBAR Institute of Dental Sciences, Takkellapadu, Guntur, Andhra Pradesh 522509 India
| | | | - Rahul Tiwari
- Narsinhbhai Patel Dental College and Hospital, Sankalchand Patel University, Visnagar, Gujarat India
| | | | - Roopa Rani Sreeram
- SIBAR Institute of Dental Sciences, Takkellapadu, Guntur, Andhra Pradesh 522509 India
| |
Collapse
|
2
|
Suspension-expansion pharyngoplasty: a modified technique for oropharyngeal collapse in obstructive sleep apnea. Eur Arch Otorhinolaryngol 2023; 280:1343-1351. [PMID: 36284008 DOI: 10.1007/s00405-022-07688-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/04/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE Lateral pharyngeal wall (LPW) collapse plays a fundamental role in the pathogenesis of obstructive sleep apnea (OSA) and might determine the severity of the disease. This study presents the suspension/expansion pharyngoplasty (SEP) for the treatment of selected cases of OSA. The procedure aimed to splint LPW collapse via supporting and lateralization of both superior constrictor muscle (SCM) and palatopharyngeal muscle (PPM) individually and in two different planes. METHODS Twenty-one adult patients with single-level OSA who showed a lateral pattern of collapse at the oropharyngeal region had the modified procedure (SEP). The basic steps are the individual dissection of the muscular components of the lateral pharyngeal wall: SCM which was sutured anteriorly to the anterior tonsillar pillar and the PPM which was suspended to the pterygomandibular raphe. The supra-tonsillar fat was preserved. RESULTS At 9-12 months, highly significant improvement was reported as regards the mean Apnea hypopnea index and the mean lowest oxygen saturation (p < 0.000). The Epworth Sleepiness Scale and VAS-snoring showed a significant (p < 0.05) reduction. The oxygen desaturation index showed significant improvement. Non-significant improvements were reported as regards the percentage of total sleep time with oxygen saturation below 90%. According to Sher criteria, successful outcomes were reported in 17 patients. CONCLUSION SEP could widen the pharyngeal airway and could support the collapsible lateral pharyngeal wall guarding against soft tissue collapse. In selected subjects, SEP had reported subjective and objective favorable outcomes with no significant comorbidities. The procedure could be combined with other procedures in multilevel surgery. LEVEL OF EVIDENCE: 4
Collapse
|
3
|
Kent D, Stanley J, Aurora RN, Levine CG, Gottlieb DJ, Spann MD, Torre CA, Green K, Harrod CG. Referral of adults with obstructive sleep apnea for surgical consultation: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med 2021; 17:2507-2531. [PMID: 34351849 PMCID: PMC8726364 DOI: 10.5664/jcsm.9594] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/03/2021] [Accepted: 08/03/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION This systematic review provides supporting evidence for the accompanying clinical practice guideline on the referral of adults with obstructive sleep apnea (OSA) for surgical consultation. METHODS The American Academy of Sleep Medicine commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies that compared the use of upper airway sleep apnea surgery or bariatric surgery to no treatment as well as studies that reported on patient-important and physiologic outcomes pre- and postoperatively. Statistical analyses were performed to determine the clinical significance of using surgery to treat obstructive sleep apnea in adults. Finally, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process was used to assess the evidence for making recommendations. RESULTS The literature search resulted in 274 studies that provided data suitable for statistical analyses. The analyses demonstrated that surgery as a rescue therapy results in a clinically significant reduction in excessive sleepiness, snoring, blood pressure (BP), apnea-hypopnea index (AHI), respiratory disturbance index (RDI), and oxygen desaturation index (ODI); an increase in lowest oxygen saturation (LSAT) and sleep quality; and an improvement in quality of life in adults with OSA who are intolerant or unaccepting of positive airway pressure (PAP) therapy. The analyses demonstrated that surgery as an adjunctive therapy results in a clinically significant reduction in optimal PAP pressure and improvement in PAP adherence in adults with OSA who are intolerant or unaccepting of PAP due to side effects associated with high pressure requirements. The analyses also demonstrated that surgery as an initial treatment results in a clinically significant reduction in AHI/RDI, sleepiness, snoring, BP, and ODI and an increase in LSAT in adults with OSA and major anatomical obstruction. Analysis of bariatric surgery data showed a clinically significant reduction in BP, AHI/RDI, sleepiness, snoring, optimal PAP level, BMI, and ODI and an increase in LSAT in adults with OSA and obesity. Analyses of very limited evidence suggested that upper airway surgery does not result in a clinically significant increase in risk of serious persistent adverse events and suggested that bariatric surgery may result in a clinically significant risk of iron malabsorption that may be managed with iron supplements. The task force provided a detailed summary of the evidence along with the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations. CITATION Kent D, Stanley J, Aurora RN, et al. Referral of adults with obstructive sleep apnea for surgical consultation: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med. 2021;17(12):2507-2531.
Collapse
Affiliation(s)
- David Kent
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - R. Nisha Aurora
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | - Daniel J. Gottlieb
- VA Boston Healthcare System, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Carlos A. Torre
- University of Miami, Miller School of Medicine, Miami, Florida
| | | | | |
Collapse
|
4
|
Askar S, Awad A, Oraby T, Khazbak A. Trans-hyoid hyoidthyroidpexy: A modified technique for selected cases of obstructive sleep apnea. Am J Otolaryngol 2021; 42:103159. [PMID: 34364106 DOI: 10.1016/j.amjoto.2021.103159] [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] [Received: 03/29/2021] [Accepted: 07/17/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Hypopharyngeal collapse (HC) considered a challenge in surgery of obstructive sleep apnea (OSA). Several procedures were presented to deal with HC indirectly via providing support to the lateral walls of the hypopharynx preventing transverse collapse but hyoidthryoidpexy had gained more popularity. The procedure aimed to fix the mobile hyoid bone to a rigid mid-line neck structure, thus preventing the bone and its attached muscles from collapsing during sleep with the negative intrathoracic pressure on inspiration. STUDY DESIGN A prospective case series study. METHODS From April 2018 to January 2020, A Modified Technique of Trans hyoid hyoidthyroidpexy was applied for all included patients (24) patients with symptoms of OSA showing predominant lateral wall collapse of the hypopharynx (with retro-palatal collapse) with other OSA surgery. RESULTS 6-8 months postoperatively, the Apnea Hypopnea index dropped from 43.75 ± 8.44 to 16.28 ± 7.35 (P < 0.0001; t = 10.6988). 14 patients (58.33%) were reported as successful while 7 patients (29.17%) were considered responders and three patients (12.5%) were considered non responders. The mean lowest oxygen desaturation elevated from 77.56 ± 5.64 to 92.38 ± 6.25 (p < 0.0001). Epworth Sleepiness Scale improved (P < 0.0001) from 16.85 ± 4.23 to 5.17 ± 3.89. CONCLUSION Trans-hyoid hyoidthyroidpwxy is a modified technique of hyoidthyroidpexy. The procedure reported good outcomes in treating OSA. It is a simple, cost-effective and less traumatic technique. It could be combined with other multilevel surgical procedures.
Collapse
|
5
|
Zhou N, Ho JPTF, Huang Z, Spijker R, de Vries N, Aarab G, Lobbezoo F, Ravesloot MJL, de Lange J. Maxillomandibular advancement versus multilevel surgery for treatment of obstructive sleep apnea: A systematic review and meta-analysis. Sleep Med Rev 2021; 57:101471. [PMID: 33831676 DOI: 10.1016/j.smrv.2021.101471] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/03/2021] [Accepted: 02/18/2021] [Indexed: 12/12/2022]
Abstract
Multilevel surgery (MLS) and maxillomandibular advancement surgery (MMA) are two established options in surgical management of obstructive sleep apnea (OSA), which target different levels of airway obstruction. The objective of this review was to comparatively evaluate the clinical efficacy and safety of MMA and MLS in the treatment of OSA. MEDLINE and Embase databases were searched for studies on MMA and/or MLS in OSA patients. Twenty MMA studies and 39 MLS studies were identified. OSA patients who underwent MMA showed significant improvements in AHI, LSAT, ODI, and ESS by -46.2/h, 13.5%, -30.3/h, and -8.5, respectively. The pooled rates of surgical success and cure for MMA were 85.0% and 46.3%, respectively. Patients who underwent MLS showed significant improvements in AHI, LSAT, ODI, and ESS by -24.7/h, 8.7%, -19.1/h, and -5.8, respectively. The pooled surgical success and cure rates for MLS were 65.1% and 28.1%, respectively. The rates of major complication of MMA and MLS were 3.2% and 1.1%, respectively, and the rate of minor complication of MMA was higher than that of MLS. We conclude that both MMA and MLS are effective treatment options for OSA. Compared to MLS, MMA may be more effective in improving OSA. However, the complication rate of MMA is higher.
Collapse
Affiliation(s)
- Ning Zhou
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC Location AMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, the Netherlands; Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Jean-Pierre T F Ho
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC Location AMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, the Netherlands
| | - Zhengfei Huang
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Clinical Neurophysiology, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, the Netherlands
| | - René Spijker
- Medical Library, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Nico de Vries
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Otorhinolaryngology - Head and Neck Surgery, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, the Netherlands; Department of Otorhinolaryngology - Head and Neck Surgery, Antwerp University Hospital (UZA), Antwerp, Belgium
| | - Ghizlane Aarab
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Madeline J L Ravesloot
- Department of Otorhinolaryngology - Head and Neck Surgery, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, the Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC Location AMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
6
|
Askar SM, El-Anwar MW, Quriba AS. Positional awake nasoendoscopic pattern-based surgical decision for correction of retropalatal obstruction in OSA. Eur Arch Otorhinolaryngol 2021; 278:901-909. [PMID: 33386971 DOI: 10.1007/s00405-020-06559-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/10/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE To evaluate differential surgical interventions for obstructive sleep apnea (OSA) patients with single-level retropalatal based on the preoperative topographical diagnosis using nasoendoscopy with Müller's maneuver during supine position (MM-P). SUBJECTS AND METHODS This case series included adult patients with OSA who showed a predominant single-level retropalatal collapse on MM-P. An anteroposterior pattern of collapse was managed by an anterior advancement procedure, while a transverse pattern of collapse was managed by lateral/anterolateral advancement procedures (double suspension sutures). A combined procedure was provided to the concentric type of collapse. All patients underwent evaluation of the polysomnography, Epworth Sleepiness Scale (ESS) values and snoring scores both preoperatively and 6-8 months after surgery. RESULTS Among 102 patients, the most commonly reported pattern of collapse at the retropalatal level was the concentric pattern (48.04%) followed by the transverse pattern (27.45%). The AP-pattern of collapse was reported in 24.51%. In the postoperative follow-up visits, no early or late complications were reported. All included groups showed significant improvement in polysomnographic data (mean AHI and lowest O2 saturation level). Significant improvement of VAS of snoring was reported. The overall success rate was ˃90%. CONCLUSION Preoperative differential diagnosis of OSA with MM-P allows for tailored surgical management. Tailored procedures could yield good surgical outcomes when patients are properly selected and the technique is chosen according to preoperative topographical diagnostic assessment. This study might provide an available less-costly and effective preoperative planning for OSA intervention. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- Sherif Mohammad Askar
- Head and Neck Surgery, Otorhinolaryngology, Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Othman Bin Affan St., Zagazig, Sharkia Governorate, Egypt.
| | - Mohammad Waheed El-Anwar
- Head and Neck Surgery, Otorhinolaryngology, Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Othman Bin Affan St., Zagazig, Sharkia Governorate, Egypt
| | - Amal Saeed Quriba
- Phoniatric Unit, Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| |
Collapse
|
7
|
Hyoid Periosteum Sutures: A Modified Tissue-Preserving Hyoid Suspension Technique for Obstructive Sleep Apnea. J Craniofac Surg 2019; 30:e231-e233. [PMID: 30730515 DOI: 10.1097/scs.0000000000005187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To present and assess a new, simple, conservative modification of hyoidthyroidpexy using 2 sutures between hyoid periosteum and thyroid lamina. METHODS Included patients had obstructive sleep apnea with apnea hypopnea index >20. Through a small midline neck incision, 2 Vicryl sutures were applied between the hyoid periosteum and thyroid cartilage. Infrahyoid and suprahyoid muscles were not traumatized. RESULTS In 19 patients, the mean apnea hypopnea index significantly dropped (P < 0.0001) from 51.5 ± 11.9 preoperatively to 10.1 ± 4.9 postoperatively. The mean lowest oxygen saturation significantly increased from 79.2 ± 10.2 to 89.5 ± 8.1 (P = 0.0015). Moreover, Epworth sleepiness scale showed significant improvements (P < 0.0001) as its mean diminished from 13.8 ± 2.9 to 5.3 ± 2.9. CONCLUSION The hyoid periosteum sutures technique (simple modification of hyoidthyroidpexy) is considered effective easily applicable, less costly with limited tissue dissection. It could be combined with other procedures in multilevel surgery for obstructive sleep apnea.
Collapse
|
8
|
Could Nasal Surgery Affect Multilevel Surgery Results for Obstructive Sleep Apnea? J Craniofac Surg 2018; 29:1897-1899. [PMID: 30169452 DOI: 10.1097/scs.0000000000004883] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To study the role of nasal surgery as a part of multilevel surgery for management of obstructive sleep apnea (OSA). METHODS All patients underwent multilevel surgery for relieving OSA symptoms and they were classified according to type of surgical intervention into: group A (20 patients), who underwent hyoid suspension (Hyoidthyroidpexy), tonsillectomy, suspension (El-Ahl and El-Anwar) sutures and nasal surgery (inferior turbinate surgery). Group B (20 patients), who underwent hyoid suspension (Hyoidthyroidpexy), tonsillectomy and suspension sutures. Pre and postoperative sleep study, Epworth sleepiness scale, snoring score were reported and compared. RESULTS Apnea hypoapnea index (AHI) dropped significantly in both groups. The mean preoperative AHI was significantly less in patients who had no nasal obstruction (P = 0.0367), while the difference in postoperative values was nonsignificant (P = 0.7358).The mean Epworth sleepiness scale improved significantly in both groups, but the difference between pre and postoperative values in both groups was nonsignificant. The lowest oxygen saturation elevated significantly in both groups, but the difference between pre and postoperative values in both groups was nonsignificant. As regards snoring scores, they dropped significantly in both groups. The preoperative snoring score was reported to be significantly more in patients who had associated nasal obstruction (group A) (P = 0.0113). But after surgery the difference in postoperative values was nonsignificant (P = 0.1296). CONCLUSION Treatment of nasal obstruction should be considered a crucial component in the comprehensive management plan for OSA patients as it has significant impact on the patients' AHI and snoring.
Collapse
|
9
|
Askar SM, El-Anwar MW, Awad A. Expansion Hyoidthyroidpexy: Combined Hyoid Surgery Techniques for Obstructive Sleep Apnea: All in One. Otolaryngol Head Neck Surg 2018; 160:355-358. [DOI: 10.1177/0194599818815658] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We provide expansion hyoidthyroidpexy as a novel surgical procedure for obstructive sleep apnea (OSA) that could combine different techniques of hyoid bone surgery in 1 procedure. This case series included patients with OSA who had an apnea-hypopnea index (AHI) >15 and showed predominant lateral wall hypopharyngeal collapse. In 21 patients, the procedure was performed smoothly without technical difficulties or operative adverse events, resulting in lateral expansion of each horn of the hyoid bone by ≥1 cm without early or late complications. At 6 months postoperatively, both AHI and the mean lowest oxygen saturation level were significantly improved ( P < .0001). The new expansion hyoidthyroidpexy technique is a reliable, easy, and effective procedure with good surgical outcomes in patients with OSA. It is feasible to be employed in the protocol of multilevel surgery for OSA.
Collapse
Affiliation(s)
- Sherif M. Askar
- Otorhinolaryngology, Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Egypt
| | - Mohammad Waheed El-Anwar
- Otorhinolaryngology, Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Egypt
| | - Ali Awad
- Otorhinolaryngology, Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Egypt
| |
Collapse
|
10
|
Askar SM, El-Anwar MW, Awad A. Modified anterior palatoplasty and double suspension sutures (with or without tonsillectomy) in selected patients with obstructive sleep apnea: a preliminary report. Sleep Breath 2018; 22:789-795. [PMID: 29777431 DOI: 10.1007/s11325-018-1671-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/01/2018] [Accepted: 05/08/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Retropalatal region might be considered the most common site of obstruction in patients with snoring and OSA. We aimed at presentation of two combined techniques: modified anterior palatoplasty (MAP) and bilateral double suspension suture (DSS). METHODS This prospective study was conducted on OSA patients with retro-palatal collapse only that was confirmed by nasoendoscopy during Muller's maneuver and drug induced sleep endoscopy. MAP and DSS were performed for all patients. Preoperative and 6 months after surgery, all patients underwent fiber-optic nasoendoscopy using the Muller maneuver and polysomnography, snoring scores, and Epworth Sleepiness Scale (ESS) values were assessed. RESULTS Mean apnea hypopnea index (AHI) dropped significantly (p < 0.0001) from a mean of 28.6 ± 5.5 preoperatively to 8.3 ± 2.96 postoperatively. Successful outcome was reported in 26 patients (98.65%) while 3 patients (10.35%) were responders. The mean lowest oxygen (O2) saturation level increased significantly from 79.4 ± 3.5 to 93.1 ± 3.1 (p < 0.0001). ESS showed significant improvement (p < 0.0001) as its mean diminished from 14.5 ± 2.4 preoperatively to 3.4 ± 1 postoperatively. Visual analog scale of snoring was significantly (p < 0.0001) decreased from 7.9 ± 1.3 preoperatively to 1.9 ± 1.2 postoperatively. No early or late complications were reported. CONCLUSION Combined MAP and DSS (± tonsillectomy) could be considered as simple, reliable, easily trained, effective, and safe surgical treatment option for OSA patients with predominant retropalatal obstruction. It could be employed in a single-stage, multilevel work-up.
Collapse
Affiliation(s)
- Sherif M Askar
- Otorhinolaryngology, Head and Neck Surgery, Otorhinolaryngology, Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Omar Bin El-Khattab street, Zagazig City, Sharkia Governorate, Egypt.
| | - Mohammad W El-Anwar
- Otorhinolaryngology, Head and Neck Surgery, Otorhinolaryngology, Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Omar Bin El-Khattab street, Zagazig City, Sharkia Governorate, Egypt
| | - Ali Awad
- Otorhinolaryngology, Head and Neck Surgery, Otorhinolaryngology, Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Omar Bin El-Khattab street, Zagazig City, Sharkia Governorate, Egypt
| |
Collapse
|
11
|
Askar S, Quriba A, Hassan E, Awad A, Bessar A. Voice and Swallowing Outcomes after Hyoid Suspension Surgery in Patients with Obstructive Sleep Apnea. Folia Phoniatr Logop 2018; 69:271-277. [DOI: 10.1159/000488239] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 03/07/2018] [Indexed: 11/19/2022] Open
|
12
|
Tantawy AA, Askar SM, Amer HS, Awad A, El-Anwar MW. Hyoid Bone Suspension as a Part of Multilevel Surgery for Obstructive Sleep Apnea Syndrome. Int Arch Otorhinolaryngol 2017; 22:266-270. [PMID: 29983767 PMCID: PMC6033602 DOI: 10.1055/s-0037-1607227] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 09/03/2017] [Indexed: 10/29/2022] Open
Abstract
Introduction Since oropharyngeal surgery alone is often insufficient to treat obstructive sleep apnea (OSA), advances have been developed in hypopharyngeal surgery. Objective To assess hyoid suspension surgery as part of a multilevel OSA surgery, also including palatal surgery. Methods The study included patients with OSA symptoms with apnea hypopnea index (AHI) > 15. They were scheduled for hyoid suspension after a nasoendoscopy during Müller maneuver and drug induced sleep endoscopy (DISE). All patients had body mass index (BMI) < 35 kg/m2. Hyoidothyroidopexy combined with tonsillectomy and palatal suspension was performed in all cases. Results The mean AHI dropped significantly ( p < 0.0001) from 68.4 ± 25.3 preoperatively to 25.6 ± 9.52 postoperatively. The mean lowest oxygen (O 2 ) saturation level increased significantly from 66.8 ± 11.3 to 83.2 ± 2.86 ( p < 0.0001). In addition, the snoring score significantly decreased ( p < 0.0001) from a preoperative mean of 3.4 ± 0.54 to 2 ± 0.7 at 6 months postoperatively. In regard to the Epworth sleepiness scale (ESS), it showed significant improvements ( p < 0.0001) as its mean diminished from 13.8 ± 5.4 preoperatively to 5.2 ± 1.6 postoperatively. Conclusion Hyoidothyroidopexy using absorbable suture seems to produce a good outcome in treating OSA. It could be effectively and safely combined with other palatal procedures in the multilevel surgery for OSA.
Collapse
Affiliation(s)
- Abd Alzaher Tantawy
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Sherif Mohammad Askar
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Hazem Saeed Amer
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ali Awad
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohammad Waheed El-Anwar
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| |
Collapse
|
13
|
Askar S, El-Anwar M, Amer H, Awad A. Single triangular suture: A modified technique for hyoid suspension as a treatment for obstructive sleep apnea: Our experience with 24 patients. Clin Otolaryngol 2017; 42:1418-1421. [DOI: 10.1111/coa.12925] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2017] [Indexed: 11/28/2022]
Affiliation(s)
- S.M. Askar
- Otorhinolaryngology, Head and Neck Surgery Department; Faculty of Medicine; Zagazig University; Zagazig Egypt
| | - M.W. El-Anwar
- Otorhinolaryngology, Head and Neck Surgery Department; Faculty of Medicine; Zagazig University; Zagazig Egypt
| | - H.S. Amer
- Otorhinolaryngology, Head and Neck Surgery Department; Faculty of Medicine; Zagazig University; Zagazig Egypt
| | - A. Awad
- Otorhinolaryngology, Head and Neck Surgery Department; Faculty of Medicine; Zagazig University; Zagazig Egypt
| |
Collapse
|
14
|
Tetter N, Tschopp K. Contribution of Hyoid and Tonsillar Procedures to Outcome in Multilevel Surgery for Obstructive Sleep Apnea Syndrome. ORL J Otorhinolaryngol Relat Spec 2017; 78:353-360. [PMID: 28343217 DOI: 10.1159/000458445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 01/27/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND/OBJECTIVE In multilevel surgery for obstructive sleep apnea (OSA), the contribution of distinct operative steps is still unclear. The aim of the present study is to retrospectively compare different combinations of multilevel surgeries in order to estimate the contribution of hyoid and tonsillar procedures to the outcome. METHODS A total of 45 patients were selected in a retrospectively matched case-control study from a database of patients who underwent surgery for OSA at our institution: group A (n = 15) had hyoid suspension, tonsillectomy, and radiofrequency-assisted uvulopalatoplasty (RAUP); group B (n = 15) had hyoid pharyngoplasty with resection of the hyoid body and preepiglottic fat tissue, tonsillectomy, and RAUP; and group C (n = 15) had hyoid suspension and RAUP but no tonsillectomy, because the tonsils had already been removed. The apnea-hypopnea index (AHI) was defined as the primary outcome measure. RESULTS The postoperative AHI significantly improved in groups A and B, in which all patients had a tonsillectomy. However, the improvement in the patients of group C, who had no tonsillectomy, was not significant (p = 0.08). CONCLUSION The patients having undergone multilevel surgery without tonsillectomy showed significantly poorer postoperative results, suggesting that the effectiveness of hyoid procedures at the level of the hypopharynx may be limited. However, removal of the tonsils is a major predictive factor for postoperative success.
Collapse
Affiliation(s)
- Nora Tetter
- ENT Clinic, Cantonal Hospital Basel-Country, Liestal, Switzerland
| | | |
Collapse
|
15
|
Verse T, Wenzel S, Brus J. Multi-level surgery for obstructive sleep apnea. Lingual tonsillectomy vs. hyoid suspension in combination with radiofrequency of the tongue base. Sleep Breath 2015; 19:1361-6. [DOI: 10.1007/s11325-015-1241-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 07/23/2015] [Accepted: 08/07/2015] [Indexed: 11/30/2022]
|
16
|
Chen S, Shi S, Xia Y, Zhu M, Zhang C, Xia S, Zheng H. A Prospective Study of the Surgical Outcome of Simple Uvulopalatopharyngoplasty (UPPP), UPPP Combined With Genioglossus Advancement or Tongue Base Advancement for Obstructive Sleep Apnea Hypopnea Syndrome Patients With Multilevel Obstruction. Clin Exp Otorhinolaryngol 2015; 8:136-41. [PMID: 26045912 PMCID: PMC4451538 DOI: 10.3342/ceo.2015.8.2.136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 11/14/2013] [Accepted: 11/22/2013] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To investigate the surgical outcomes of different uvulopalatopharyngoplasty (UPPP). METHODS All subjects underwent overnight polysomnography and were evaluated using the Epworth sleepiness scale (ESS), the Quebec sleep questionnaire and the snoring scale at the baseline and 3 and 12 months following operation. The primary endpoint was the overall effective rate representing the sum of the surgical success rate and effective rate. RESULTS The overall effective rate at 12 months post surgery was 55.6% for simple UPPP, 95.8% for UPPP+GA, and 92.3% for UPPP+TBA. The surgical success rate at 3 and 12 months postoperation for UPPP+GA or UPPP+TBA was significantly higher than simple UPPP (P<0.05). Marked improvement was observed in all patients in the snoring scale score and the ESS score 3 and 12 months following surgery compared to the baseline (P<0.05 in all). CONCLUSION UPPP, UPPP+GA, and UPPP+TBA are all effective in improving the surgical outcome of obstructive sleep apnea hypopnea syndrome (OSAHS) patients with multilevel obstruction. UPPP+TBA appears to be the most effective in treating OSAHS patients.
Collapse
Affiliation(s)
- Shicai Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, Changhai Hospital, Second Military Medical University of PLA, Shanghai, China
| | - Song Shi
- Department of Otorhinolaryngology-Head and Neck Surgery, Changhai Hospital, Second Military Medical University of PLA, Shanghai, China
| | - Yanghui Xia
- Department of Otorhinolaryngology-Head and Neck Surgery, Changhai Hospital, Second Military Medical University of PLA, Shanghai, China
| | - Minhui Zhu
- Department of Otorhinolaryngology-Head and Neck Surgery, Changhai Hospital, Second Military Medical University of PLA, Shanghai, China
| | - Caiyun Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, Changhai Hospital, Second Military Medical University of PLA, Shanghai, China
| | - Siwen Xia
- Department of Otorhinolaryngology-Head and Neck Surgery, Changhai Hospital, Second Military Medical University of PLA, Shanghai, China
| | - Hongliang Zheng
- Department of Otorhinolaryngology-Head and Neck Surgery, Changhai Hospital, Second Military Medical University of PLA, Shanghai, China
| |
Collapse
|
17
|
Piccin O, Scaramuzzino G, Martone C, Marra F, Gobbi R, Sorrenti G. Modified Hyoid Suspension Technique in the Treatment of Multilevel Related Obstructive Sleep Apnea. Otolaryngol Head Neck Surg 2013; 150:321-4. [DOI: 10.1177/0194599813514532] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Using the Hörmann technique of hyoid suspension in sleep apnea surgery, a steel wire is placed through the thyroid cartilage and slung around the hyoid bone. However, we experienced thyroid cartilage fracture by steel wire traction. A modification is presented to avoid thyroid cartilage fracture. Study Design Case series with chart review. Setting University hospital. Subjects and Methods Twenty-seven patients affected by obstructive sleep apnea syndrome underwent Hörmann hyoid suspension. In 2 patients, the steel wire caused a fracture of the thyroid cartilage. The technique was therefore modified in 25 subsequent patients. The wire is threaded through an adaptation titanium miniplate placed on the surface of the thyroid cartilage. Results The apnea-hypopnea index decreased from 43.1 to 10.9/h. Nineteen patients (76%) met the criteria for a successful outcome. No complications related to this modification were noted. Conclusions The Hörmann hyoid suspension is a procedure that advances the hyoid bone to expand the airway, and its effectiveness has been proven previously. The modified hyoid suspension presented here promises similar results without the risk of serious complications such as thyroid cartilage fracture.
Collapse
Affiliation(s)
- Ottavio Piccin
- Department of Otolaryngology Head and Neck Surgery, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Giuseppe Scaramuzzino
- Department of Otolaryngology Head and Neck Surgery, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Chiara Martone
- Department of Otolaryngology Head and Neck Surgery, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Francesca Marra
- Department of Otolaryngology Head and Neck Surgery, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Riccardo Gobbi
- Department of Otolaryngology Head and Neck Surgery, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Giovanni Sorrenti
- Department of Otolaryngology Head and Neck Surgery, S. Orsola-Malpighi University Hospital, Bologna, Italy
| |
Collapse
|
18
|
The undervalued potential of positional therapy in position-dependent snoring and obstructive sleep apnea-a review of the literature. Sleep Breath 2012; 17:39-49. [PMID: 22441662 PMCID: PMC3575552 DOI: 10.1007/s11325-012-0683-5] [Citation(s) in RCA: 140] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 01/20/2012] [Accepted: 03/05/2012] [Indexed: 11/15/2022]
Abstract
Purpose Research during the past 10–20 years shows that positional therapy (PT) has a significant influence on the apnea–hypopnea index. These studies are predominantly performed as case series on a comparably small number of patients. Still, results have not found their way into the daily diagnostic and treatment routine. An average of 56 % of patients with obstructive sleep apnea (OSA) have position-dependent OSA (POSA), commonly defined as a difference of 50 % or more in apnea index between supine and non-supine positions. A great deal could be gained in treating patients with POSA with PT. The aim of this paper was to perform a thorough review of the literature on positional sleep apnea and its therapy. Methods A broad search strategy was run electronically in the MEDLINE and EMBASE databases using synonyms for position and sleep apnea. Results Sixteen studies were found which examined the effect of PT on OSA. In this literature review, we discuss the various techniques, results, and compliance rates. Conclusion Long-term compliance for PT remains an issue, and although remarkable results have been shown using innovative treatment concepts for PT, there is room for both technical improvement of the devices and for further research.
Collapse
|
19
|
Exploration of the relationship between sleep position and isolated tongue base or multilevel surgery in obstructive sleep apnea. Eur Arch Otorhinolaryngol 2012; 269:2129-36. [PMID: 22427104 PMCID: PMC3422454 DOI: 10.1007/s00405-012-1995-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 03/06/2012] [Indexed: 10/28/2022]
Abstract
This study aimed to elucidate the role of sleep position as a confounding factor on apnea hypopnea index (AHI) and surgical success in isolated tongue base or multilevel surgery. This study was conducted using retrospective analysis of patients who underwent hyoid suspension because of obstructive sleep apnea (OSA), in the St. Lucas Andreas Hospital, Amsterdam, The Netherlands, from 2004 to 2011. Concurrent surgical treatment was documented. Sleep positions and corresponding AHIs before and after surgery were compared. A total of 130 patients were included. 94 patients underwent surgery of base of tongue and palate (either uvulopalatopharyngoplasty or Z-palatoplasty), of whom 72 underwent concurrent radiofrequent thermotherapy of the base of tongue. 36 patients underwent base of tongue surgery alone, of whom 22 underwent concurrent radiofrequent thermotherapy of the base of tongue. 65 patients either had a successful reduction in AHI or in AI. Isolated tongue base or multilevel surgery was as successful on the supine AHI as it was on the AHI in other sleeping positions. Surgery was not more successful in the group with position-dependent patients as compared with the non-position-dependent patients (P = 0.615). Successful and non-successful surgical results could not be explained by variations in percentages of supine sleep position. Sleep position is not a confounding factor on surgical outcomes in tongue base surgery. The results of isolated base of tongue or multilevel surgery in position-dependent OSA patients leave room for improvement, possibly through positional therapy.
Collapse
|
20
|
Prinsell JR. Primary and secondary telegnathic maxillomandibular advancement, with or without adjunctive procedures, for obstructive sleep apnea in adults: a literature review and treatment recommendations. J Oral Maxillofac Surg 2011; 70:1659-77. [PMID: 21855196 DOI: 10.1016/j.joms.2011.03.064] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Revised: 03/04/2011] [Accepted: 03/28/2011] [Indexed: 10/17/2022]
Abstract
PURPOSE To further define the role, surgical principles, and therapeutic efficacy of primary and secondary maxillomandibular advancement (MMA), with and without intrapharyngeal or extrapharyngeal adjunctive procedures, for obstructive sleep apnea in adults. MATERIALS AND METHODS A review of the literature, using mean percent reduction in apnea hypopnea index as the primary outcome measure of therapeutic efficacy for standardized comparison. Other occasionally reported MMA outcome parameters were sleep staging variables, lowest oxyhemoglobin saturation levels, Epworth scores, blood pressure changes, lateral cephalometric data, and complications. RESULTS Mean percent reduction in apnea hypopnea index was 92.1% for primary MMA with extrapharyngeal procedures, 88.4% for primary MMA, 86.6% for secondary MMA, 79.4% for primary MMA with intrapharyngeal procedures, 53.0% for non-MMA multilevel surgery, 31.3% for uvulopalatopharyngoplasty, and 89.8% for nasal continuous positive airway pressure. Treatment recommendations for telegnathic MMA included surgical goals and guidelines, indications and staging protocols, surgical principles and techniques, and postoperative airway management. CONCLUSIONS Primary and secondary MMA are highly therapeutic, and extrapharyngeal are more therapeutic than intrapharyngeal procedures when performed concomitantly with primary MMA. However, long-term success of obstructive sleep apnea treatment should be measured by a yet undefined comprehensive algorithm of standardized multiple weighted outcome parameters.
Collapse
|
21
|
Statistical model for postoperative apnea–hypopnea index after multilevel surgery for sleep-disordered breathing. Eur Arch Otorhinolaryngol 2011; 268:1679-85. [DOI: 10.1007/s00405-010-1465-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 12/07/2010] [Indexed: 10/18/2022]
|
22
|
Caples SM, Rowley JA, Prinsell JR, Pallanch JF, Elamin MB, Katz SG, Harwick JD. Surgical modifications of the upper airway for obstructive sleep apnea in adults: a systematic review and meta-analysis. Sleep 2010; 33:1396-407. [PMID: 21061863 PMCID: PMC2941427 DOI: 10.1093/sleep/33.10.1396] [Citation(s) in RCA: 308] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A substantial portion of patients with obstructive sleep apnea (OSA) seek alternatives to positive airway pressure (PAP), the usual first-line treatment for the disorder. One option is upper airway surgery. As an adjunct to the American Academy of Sleep Medicine (AASM) Standards of Practice paper, we conducted a systematic review and meta-analysis of literature reporting outcomes following various upper airway surgeries for the treatment of OSA in adults, including maxillomandibular advancement (MMA), pharyngeal surgeries such as uvulopharyngopalatoplasty (UPPP), laser assisted uvulopalatoplasty (LAUP), and radiofrequency ablation (RFA), as well as multi-level and multi-phased procedures. We found that the published literature is comprised primarily of case series, with few controlled trials and varying approaches to pre-operative evaluation and post-operative follow-up. We include surgical morbidity and adverse events where reported but these were not systematically analyzed. Utilizing the ratio of means method, we used the change in the apnea-hypopnea index (AHI) as the primary measure of efficacy. Substantial and consistent reductions in the AHI were observed following MMA; adverse events were uncommonly reported. Outcomes following pharyngeal surgeries were less consistent; adverse events were reported more commonly. Papers describing positive outcomes associated with newer pharyngeal techniques and multi-level procedures performed in small samples of patients appear promising. Further research is needed to better clarify patient selection, as well as efficacy and safety of upper airway surgery in those with OSA.
Collapse
Affiliation(s)
- Sean M Caples
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester MN, USA
| | | | | | | | | | | | | |
Collapse
|
23
|
Chau JKM, Goode RL. Are hyoid procedures a reasonable choice in the surgical treatment of obstructive sleep apnea? Laryngoscope 2010; 120:221-2. [DOI: 10.1002/lary.20784] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|