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Published in: European Archives of Oto-Rhino-Laryngology 6/2014

01-06-2014 | Miscellaneous

Anterior palatoplasty for selected mild and moderate obstructive sleep apnea: preliminary results

Authors: Kadriye Serife Ugur, Nebil Ark, Hanifi Kurtaran, Gultekin Kizilbulut, Alper Yuksel, Mehmet Gunduz

Published in: European Archives of Oto-Rhino-Laryngology | Issue 6/2014

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Abstract

The aim of this prospective study was to evaluate the long-term efficacy anterior palatoplasty (AP) technique in treatment of patients with mild to moderate obstructive sleep apnea (OSA). Forty-two patients were diagnosed with mild to moderate OSA. Participants were treated with AP for mild or moderate OSA. Patients were evaluated with one night polysomnography before the surgery and 24 months after the surgery. Patients completed Epworth sleepiness scale (ESS), snoring VAS (visual analog scale) before and 24 months after the surgery. Forty two patients with a mean age of 39.2 ± 7.6 were included study. Success rate was 57.1 %. Total apnea-hypopnea index (AHI) values significantly decreased after 2 years (p < 0.025). Non-REM AHI and supine AHI values significantly decreased after 2 years (p < 0.025). The oxygen desaturation index changes significantly decreased after AP (p < 0.025). Snoring VAS values significantly decreased after AP (p < 0.025). ESS scores of patients significantly decreased (p < 0.001). We believe that AP is an effective, inexpensive technique for mild and moderate OSA patients.
Literature
1.
go back to reference Fujita S, Conway W, Zorick F, Roth T (1981) Surgical correction of anatomic abnormalities in obstructive sleep apnea syndrome: uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg 89(6):923–934PubMed Fujita S, Conway W, Zorick F, Roth T (1981) Surgical correction of anatomic abnormalities in obstructive sleep apnea syndrome: uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg 89(6):923–934PubMed
2.
go back to reference Friedman M, Ibrahim H, Lowenthal S, Ramakrishnan V, Joseph NJ (2004) Uvulopalatoplasty (UP2): a modified technique for selected patients. Laryngoscope 114(3):441–449PubMedCrossRef Friedman M, Ibrahim H, Lowenthal S, Ramakrishnan V, Joseph NJ (2004) Uvulopalatoplasty (UP2): a modified technique for selected patients. Laryngoscope 114(3):441–449PubMedCrossRef
3.
go back to reference Friedman M, Tanyeri H, La Rosa M, Landsberg R, Vaidyanathan K, Pieri S, Caldarelli D (1999) Clinical predictors of obstructive sleep apnea. Laryngoscope 109(12):1901–1907PubMedCrossRef Friedman M, Tanyeri H, La Rosa M, Landsberg R, Vaidyanathan K, Pieri S, Caldarelli D (1999) Clinical predictors of obstructive sleep apnea. Laryngoscope 109(12):1901–1907PubMedCrossRef
4.
go back to reference Sullivan CE, Issa FG, Berthon-Jones M, Eves L (1981) Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet 18:862–865CrossRef Sullivan CE, Issa FG, Berthon-Jones M, Eves L (1981) Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet 18:862–865CrossRef
5.
go back to reference Riley RW, Powell NB, Guilleminault C (1993) Obstructive sleep apnea syndrome: a review of 306 consecutively treated surgical patients. Otolaryngol Head Neck Surg 108:117–125PubMed Riley RW, Powell NB, Guilleminault C (1993) Obstructive sleep apnea syndrome: a review of 306 consecutively treated surgical patients. Otolaryngol Head Neck Surg 108:117–125PubMed
7.
go back to reference Kamami YV (1990) Laser CO2 for snoring: preliminary results. Acta Otorhinolaryngol Belg 44:451–456PubMed Kamami YV (1990) Laser CO2 for snoring: preliminary results. Acta Otorhinolaryngol Belg 44:451–456PubMed
8.
go back to reference Mair EA, Day RH (2000) The cautery assisted palatal stiffening operation. Otolaryngol Head Neck Surg 122:547–555PubMed Mair EA, Day RH (2000) The cautery assisted palatal stiffening operation. Otolaryngol Head Neck Surg 122:547–555PubMed
9.
go back to reference Powell NB, Riley RW, Troell RJ, Li K, Blumen MB, Guilleminault C (1998) Radiofrequency volumetric tissue reduction of the palate in subjects with sleep disordered breathing. Chest 113:1163–1174PubMedCrossRef Powell NB, Riley RW, Troell RJ, Li K, Blumen MB, Guilleminault C (1998) Radiofrequency volumetric tissue reduction of the palate in subjects with sleep disordered breathing. Chest 113:1163–1174PubMedCrossRef
10.
go back to reference Li KK, Powell NB, Riley RW, Troell RJ, Guilleminault C (2000) Radiofrequency volumetric reduction of the palate: an extended follow-up study. Otolaryngol Head Neck Surg 122:410–414PubMed Li KK, Powell NB, Riley RW, Troell RJ, Guilleminault C (2000) Radiofrequency volumetric reduction of the palate: an extended follow-up study. Otolaryngol Head Neck Surg 122:410–414PubMed
11.
go back to reference Brietzke SE, Mair EA (2001) Injection snoreplasty: how to treat snoring without all the pain and expense. Otolaryngol Head Neck Surg 124(5):503–510PubMedCrossRef Brietzke SE, Mair EA (2001) Injection snoreplasty: how to treat snoring without all the pain and expense. Otolaryngol Head Neck Surg 124(5):503–510PubMedCrossRef
12.
go back to reference Walker RP, Gatti WM, Poirier N, Davis JS (1996) Objective assessment of snoring before and after laser-assisted uvuloplasty. Laryngoscope 106:1372–1377PubMedCrossRef Walker RP, Gatti WM, Poirier N, Davis JS (1996) Objective assessment of snoring before and after laser-assisted uvuloplasty. Laryngoscope 106:1372–1377PubMedCrossRef
13.
go back to reference Terris DJ, Coker JF, Thomas AJ, Chavoya M (2002) Preliminary findings from a prospective, randomized trial of two palatal operations for sleep-disordered breathing. Otolaryngol Head Neck Surg 127(4):315–323PubMedCrossRef Terris DJ, Coker JF, Thomas AJ, Chavoya M (2002) Preliminary findings from a prospective, randomized trial of two palatal operations for sleep-disordered breathing. Otolaryngol Head Neck Surg 127(4):315–323PubMedCrossRef
14.
go back to reference Finkelstein Y, Shapiro-Feinberg M, Stein G, Ophir D (1997) Uvulopalatopharyngoplasty vs laser-assisted uvulopalatoplasty. Anatomical considerations. Arch Otolaryngol Head Neck Surg 123:265–276PubMedCrossRef Finkelstein Y, Shapiro-Feinberg M, Stein G, Ophir D (1997) Uvulopalatopharyngoplasty vs laser-assisted uvulopalatoplasty. Anatomical considerations. Arch Otolaryngol Head Neck Surg 123:265–276PubMedCrossRef
15.
go back to reference Stuck BA, Maurer JT, Verse T, Hörmann K (2002) Tongue base reduction with temperature-controlled radiofrequency volumetric tongue reduction for treatment of obstructive sleep apnea syndrome. Acta Otolaryngol 122:531–536PubMedCrossRef Stuck BA, Maurer JT, Verse T, Hörmann K (2002) Tongue base reduction with temperature-controlled radiofrequency volumetric tongue reduction for treatment of obstructive sleep apnea syndrome. Acta Otolaryngol 122:531–536PubMedCrossRef
16.
go back to reference Jacobowitz O (2006) Palatal and tongue base surgery for surgical treatment of obstructive sleep apnea: a prospective study. Otolaryngol Head Neck Surg 135(2):258–264PubMedCrossRef Jacobowitz O (2006) Palatal and tongue base surgery for surgical treatment of obstructive sleep apnea: a prospective study. Otolaryngol Head Neck Surg 135(2):258–264PubMedCrossRef
17.
go back to reference Pang KP, Woodson BT (2007) Expansion sphincter pharyngoplasty: a new technique for the treatment of obstructive sleep apnea. Otolaryngol Head Neck Surg 137(1):110–114PubMedCrossRef Pang KP, Woodson BT (2007) Expansion sphincter pharyngoplasty: a new technique for the treatment of obstructive sleep apnea. Otolaryngol Head Neck Surg 137(1):110–114PubMedCrossRef
18.
go back to reference Pang KP, Tan R, Puraviappan P, Terris DJ (2009) Anterior palatoplasty for the treatment of OSA: three-year results. Otolaryngol Head Neck Surg 141(2):253–256PubMedCrossRef Pang KP, Tan R, Puraviappan P, Terris DJ (2009) Anterior palatoplasty for the treatment of OSA: three-year results. Otolaryngol Head Neck Surg 141(2):253–256PubMedCrossRef
19.
go back to reference Pang KP, Siow JK (2009) Sutter bipolar radiofrequency volumetric tissue reduction of palate for snoring and mild obstructive sleep apnoea: is one treatment adequate? J Laryngol Otol 123(7):750–754PubMedCrossRef Pang KP, Siow JK (2009) Sutter bipolar radiofrequency volumetric tissue reduction of palate for snoring and mild obstructive sleep apnoea: is one treatment adequate? J Laryngol Otol 123(7):750–754PubMedCrossRef
20.
go back to reference Steward DL, Huntley TC, Woodson BT, Surdulescu V (2008) Palate implants for obstructive sleep apnea: multi-institution, randomized, placebo-controlled study. Otolaryngol Head Neck Surg 139(4):506–510PubMedCrossRef Steward DL, Huntley TC, Woodson BT, Surdulescu V (2008) Palate implants for obstructive sleep apnea: multi-institution, randomized, placebo-controlled study. Otolaryngol Head Neck Surg 139(4):506–510PubMedCrossRef
21.
go back to reference Woodson BT, Robinson S, Lim HJ (2005) Transpalatal advancement pharyngoplasty outcomes compared with uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg 133(2):211–217PubMedCrossRef Woodson BT, Robinson S, Lim HJ (2005) Transpalatal advancement pharyngoplasty outcomes compared with uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg 133(2):211–217PubMedCrossRef
22.
go back to reference Babademez MA, Yorubulut M, Yurekli MF, Gunbey E, Baysal S, Acar B, Karassen RM (2011) Comparison of minimally ınvasive techniques in tongue base surgery in patients with obstructive sleep apnea. Otolaryngol Head Neck Surg 145(5):858–864PubMedCrossRef Babademez MA, Yorubulut M, Yurekli MF, Gunbey E, Baysal S, Acar B, Karassen RM (2011) Comparison of minimally ınvasive techniques in tongue base surgery in patients with obstructive sleep apnea. Otolaryngol Head Neck Surg 145(5):858–864PubMedCrossRef
23.
go back to reference Saylam G, Korkmaz H, Firat H, Tatar EC, Ozdek A, Ardic S (2009) Do palatal implants really reduce snoring in long-term follow-up? Laryngoscope 119(5):1000–1004PubMedCrossRef Saylam G, Korkmaz H, Firat H, Tatar EC, Ozdek A, Ardic S (2009) Do palatal implants really reduce snoring in long-term follow-up? Laryngoscope 119(5):1000–1004PubMedCrossRef
24.
go back to reference Mallampati SR, Gatt SP, Gugino LD, Desai SP, Waraksa B, Freiberger D, Liu PL (1985) A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Sos J 32(4):429–434CrossRef Mallampati SR, Gatt SP, Gugino LD, Desai SP, Waraksa B, Freiberger D, Liu PL (1985) A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Sos J 32(4):429–434CrossRef
25.
go back to reference Terris DJ, Hanasono MM, Liu YC (2000) Reliability of the Müller maneuver and its association with sleep-disordered breathing. Laryngoscope 110:1819–1823PubMedCrossRef Terris DJ, Hanasono MM, Liu YC (2000) Reliability of the Müller maneuver and its association with sleep-disordered breathing. Laryngoscope 110:1819–1823PubMedCrossRef
26.
go back to reference Friedman M, Ibrahim H, Bass L (2002) Clinical staging for sleep disordered breathing. Otolaryngol Head Neck Surg 127(1):13–21PubMedCrossRef Friedman M, Ibrahim H, Bass L (2002) Clinical staging for sleep disordered breathing. Otolaryngol Head Neck Surg 127(1):13–21PubMedCrossRef
27.
go back to reference Iber C, Ancoli-Israel S, Chesson A, Quan S (2007) for the American Academy of Sleep Medicine: the AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. 1st edn. American Academy of Sleep Medicine; Westchester Iber C, Ancoli-Israel S, Chesson A, Quan S (2007) for the American Academy of Sleep Medicine: the AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. 1st edn. American Academy of Sleep Medicine; Westchester
28.
go back to reference Weaver EM, Woodson BT, Yueh B, Smith T, Stewart MG, Hannley M, Schulz K, Patel MM, Witsell D, SLEEP Study Investigators (2011) Studying life effects and effectiveness of palatopharyngoplasty (SLEEP) study: subjective outcomes of isolated uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg 144(4):623–631PubMedCrossRef Weaver EM, Woodson BT, Yueh B, Smith T, Stewart MG, Hannley M, Schulz K, Patel MM, Witsell D, SLEEP Study Investigators (2011) Studying life effects and effectiveness of palatopharyngoplasty (SLEEP) study: subjective outcomes of isolated uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg 144(4):623–631PubMedCrossRef
29.
go back to reference Powell N, Riley R, Guilleminault C, Troell R (1996) A reversible uvulopalatal flap for snoring and sleep apnea syndrome. Sleep 19(7):593–599PubMed Powell N, Riley R, Guilleminault C, Troell R (1996) A reversible uvulopalatal flap for snoring and sleep apnea syndrome. Sleep 19(7):593–599PubMed
30.
go back to reference Troell RJ, Powell NB, Riley RW, Li KK, Guilleminault C (2000) Comparison of postoperative pain between laser-assisted uvulopalatoplasty, uvulopalatopharyngoplasty, and radiofrequency volumetric tissue reduction of the palate. Otolaryngol Head Neck Surg 122(3):402–409PubMed Troell RJ, Powell NB, Riley RW, Li KK, Guilleminault C (2000) Comparison of postoperative pain between laser-assisted uvulopalatoplasty, uvulopalatopharyngoplasty, and radiofrequency volumetric tissue reduction of the palate. Otolaryngol Head Neck Surg 122(3):402–409PubMed
31.
go back to reference Yoruk O, Akgun M, Sutbeyaz Y, Aktan B, Ucuncu H, Tatar A, Altas E, Araz O, Erdem AF (2009) Treatment of primary snoring using modified radiofrequency-assisted uvulopalatoplasty. Eur Arch Otorhinolaryngol 266(11):1807–1814PubMedCrossRef Yoruk O, Akgun M, Sutbeyaz Y, Aktan B, Ucuncu H, Tatar A, Altas E, Araz O, Erdem AF (2009) Treatment of primary snoring using modified radiofrequency-assisted uvulopalatoplasty. Eur Arch Otorhinolaryngol 266(11):1807–1814PubMedCrossRef
32.
go back to reference Brietzke SE, Mair EA (2006) Acoustical analysis of snoring: can the probability of success be predicted? Otolaryngol Head Neck Surg 135(3):417–420PubMedCrossRef Brietzke SE, Mair EA (2006) Acoustical analysis of snoring: can the probability of success be predicted? Otolaryngol Head Neck Surg 135(3):417–420PubMedCrossRef
33.
go back to reference Friedman M, Ibrahim H, Joseph NJ (2004) Staging of obstructive sleep apnea/hypopnea syndrome: a guide to appropriate treatment. Laryngoscope 114:454–459PubMedCrossRef Friedman M, Ibrahim H, Joseph NJ (2004) Staging of obstructive sleep apnea/hypopnea syndrome: a guide to appropriate treatment. Laryngoscope 114:454–459PubMedCrossRef
34.
go back to reference Friedman M, Ibrahim H, Lee G, Joseph NJ (2003) Combined uvulopalatopharyngoplasty and radiofrequency tongue base reduction for treatment of obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surg 129(6):611–621PubMedCrossRef Friedman M, Ibrahim H, Lee G, Joseph NJ (2003) Combined uvulopalatopharyngoplasty and radiofrequency tongue base reduction for treatment of obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surg 129(6):611–621PubMedCrossRef
35.
go back to reference Pang KP, Terris DJ, Podolsky R (2006) Severity of obstructive sleep apnea: correlation with clinical examination and patient perception. Otolaryngol Head Neck Surg 135(4):555–560PubMedCrossRef Pang KP, Terris DJ, Podolsky R (2006) Severity of obstructive sleep apnea: correlation with clinical examination and patient perception. Otolaryngol Head Neck Surg 135(4):555–560PubMedCrossRef
36.
go back to reference Gislason T, Lindholm CE, Almqvist M, Birring E, Boman G, Eriksson G, Larsson SG, Lidell C, Svanholm H (1988) Uvulopalatopharyngoplasty in the sleep apnea syndrome. Arch Otolaryngol Head Neck Surg 114(1):45–51PubMedCrossRef Gislason T, Lindholm CE, Almqvist M, Birring E, Boman G, Eriksson G, Larsson SG, Lidell C, Svanholm H (1988) Uvulopalatopharyngoplasty in the sleep apnea syndrome. Arch Otolaryngol Head Neck Surg 114(1):45–51PubMedCrossRef
37.
go back to reference Thong JF, Pang KP (2008) Clinical parameters in obstructive sleep apnea: are there any correlations? J Otolaryngol Head Neck Surg 37(6):894–900PubMed Thong JF, Pang KP (2008) Clinical parameters in obstructive sleep apnea: are there any correlations? J Otolaryngol Head Neck Surg 37(6):894–900PubMed
38.
go back to reference Weaver EM, Woodson BT, Steward DL (2005) Polysomnography indexes are discordant with quality of life, symptoms, and reaction times in sleep apnea patients. Otolaryngol Head Neck Surg 132(2):255–262PubMedCrossRef Weaver EM, Woodson BT, Steward DL (2005) Polysomnography indexes are discordant with quality of life, symptoms, and reaction times in sleep apnea patients. Otolaryngol Head Neck Surg 132(2):255–262PubMedCrossRef
39.
go back to reference Levin BC, Becker GD (1994) Uvulopalatopharyngoplasty for snoring: long-term results. Laryngoscope 104:1150–1152PubMedCrossRef Levin BC, Becker GD (1994) Uvulopalatopharyngoplasty for snoring: long-term results. Laryngoscope 104:1150–1152PubMedCrossRef
40.
go back to reference Hicklin LA, Tostevin P, Dasan S (2000) Retrospective survey of long-term results and patient satisfaction with uvulopalatopharyngoplasty for snoring. J Laryngol Otol 114(9):675–681PubMedCrossRef Hicklin LA, Tostevin P, Dasan S (2000) Retrospective survey of long-term results and patient satisfaction with uvulopalatopharyngoplasty for snoring. J Laryngol Otol 114(9):675–681PubMedCrossRef
41.
go back to reference Coleman SC, Smith TL (2000) Midline radiofrequency tissue reduction of the palate for bothersome snoring and sleep-disordered breathing: a clinical trial. Otolaryngol Head Neck Surg 122(3):387–394PubMed Coleman SC, Smith TL (2000) Midline radiofrequency tissue reduction of the palate for bothersome snoring and sleep-disordered breathing: a clinical trial. Otolaryngol Head Neck Surg 122(3):387–394PubMed
42.
go back to reference Haavisto L, Suonpää J (1994) Complications of uvulopalatopharyngoplasty. Clin Otolaryngol Allied Sci 19(3):243–247PubMedCrossRef Haavisto L, Suonpää J (1994) Complications of uvulopalatopharyngoplasty. Clin Otolaryngol Allied Sci 19(3):243–247PubMedCrossRef
Metadata
Title
Anterior palatoplasty for selected mild and moderate obstructive sleep apnea: preliminary results
Authors
Kadriye Serife Ugur
Nebil Ark
Hanifi Kurtaran
Gultekin Kizilbulut
Alper Yuksel
Mehmet Gunduz
Publication date
01-06-2014
Publisher
Springer Berlin Heidelberg
Published in
European Archives of Oto-Rhino-Laryngology / Issue 6/2014
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI
https://doi.org/10.1007/s00405-013-2701-z

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