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European Archives of Oto-Rhino-Laryngology

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01-08-2020 | Sleep Apnea | Miscellaneous

The comparison of multilevel surgery (hyoid myotomy and suspension with uvulopalatopharyngoplasty) with CPAP in moderate to severe OSAS patients

Authors: Mei-Chen Yang, Yen-Bin Hsu, Ming-Ying Lan, Ming-Chin Lan

Published in: European Archives of Oto-Rhino-Laryngology | Issue 8/2020

Abstract

Purpose

The study aimed to determine the efficacy of multilevel surgery (hyoid myotomy and suspension with uvulopalatopharyngoplasty) and continuous positive airway pressure (CPAP) for the treatment of moderate to severe obstructive sleep apnea syndrome (OSAS) and to clarify whether our surgical protocol could be as effective as CPAP.

Methods

We conducted a case series study comparing the effects of multilevel surgery and CPAP in the same subjects to minimize the influence of confounding factors. Fifteen subjects were enrolled with a pretreatment apnea–hypopnea index (AHI) ≥ 15.

Results

Both CPAP and multilevel surgery could improve the AHI and oxygen desaturation index (ODI). The median AHI for baseline, CPAP and surgery were 38.9, 1.2 and 12.6, respectively (p < 0.001). The medina ODI for baseline, CPAP and surgery were 34.8, 0.9 and 7.2, respectively (p < 0.001). However, the results indicated CPAP as the more efficacious treatment modality compared with multilevel surgery. Moreover, CPAP not only decreased N1 sleep but also had beneficial effects on blood pressure control, whereas multilevel surgery did not have any significant difference.

Conclusion

CPAP is efficacious in improving OSAS severity, oxygen desaturation, sleep stage, and blood pressure control; while hyoid myotomy and suspension with uvulopalatopharyngoplasty are only efficacious in improving OSAS severity and oxygen desaturation. This study suggested that CPAP is the first choice when considering treatment of OSAS, especially in patients with hypertension or other cardiovascular diseases.

Veasey SC, Rosen IM (2019) Obstructive sleep apnea in adults. N Engl J Med 380(15):1442–1449CrossRef

Rotenberg BW, Murariu D, Pang KP (2016) Trends in cpap adherence over twenty years of data collection: a flattened curve. J Otolaryngol Head Neck Surg 45(1):43CrossRef

May AM, Gharibeh T, Wang L, Hurley A, Walia H, Strohl KP, Mehra R (2018) Cpap adherence predictors in a randomized trial of moderate-to-severe osa enriched with women and minorities. Chest 154(3):567–578CrossRef

Lan MC, Liu SY, Lan MY, Modi R, Capasso R (2015) Lateral pharyngeal wall collapse associated with hypoxemia in obstructive sleep apnea. Laryngoscope 125(10):2408–2412CrossRef

Handler E, Hamans E, Goldberg AN, Mickelson S (2014) Tongue suspension: an evidence-based review and comparison to hypopharyngeal surgery for osa. Laryngoscope 124(1):329–336CrossRef

Mandavia R, Mehta N, Veer V (2020) Guidelines on the surgical management of sleep disorders: a systematic review. Laryngoscope 130(4):1070–1084CrossRef

Riley RW, Powell NB, Guilleminault C (1986) Inferior sagittal osteotomy of the mandible with hyoid myotomy-suspension: a new procedure for obstructive sleep apnea. Otolaryngol Head Neck Surg 94(5):589–593CrossRef

Guilleminault C, Riley R, Powell N (1984) Obstructive sleep apnea and abnormal cephalometric measurements. Implications for treatment. Chest 86(5):793–794CrossRef

Young JW, McDonald JP (2004) An investigation into the relationship between the severity of obstructive sleep apnoea/hypopnoea syndrome and the vertical position of the hyoid bone. Surgeon 2(3):145–151CrossRef

10.

Riley RW, Powell NB, Guilleminault C (1989) Inferior mandibular osteotomy and hyoid myotomy suspension for obstructive sleep apnea: a review of 55 patients. J Oral Maxillofac Surg 47(2):159–164CrossRef

11.

Chen NH, Johns MW, Li HY, Chu CC, Liang SC, Shu YH, Chuang ML, Wang PC (2002) Validation of a chinese version of the epworth sleepiness scale. Qual Life Res 11(8):817–821CrossRef

12.

Rechtschaffen A, Kales A (1968) A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. U. S. National Institute of Neurological Diseases and Blindness, Neurological Information Network

13.

Sher AE, Schechtman KB, Piccirillo JF (1996) The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep 19(2):156–177CrossRef

14.

Lu YT, Tai SK, Lee TL (2018) Pterygomandibular suspension suture: a simple modification of uvulopalatopharyngoplasty for severe obstructive sleep apnea. Eur Arch Otorhinolaryngol 275(1):269–273CrossRef

15.

Gillespie MB, Ayers CM, Nguyen SA, Abidin MR (2011) Outcomes of hyoid myotomy and suspension using a mandibular screw suspension system. Otolaryngol Head Neck Surg 144(2):225–229CrossRef

16.

Guzeldir OT, Aydil U, Kizil Y, Akyildiz I, Koybasioglu A (2015) The effect of infrahyoid muscle sectioning on hyoid bone position and oropharyngeal air column volume. Laryngoscope 125(6):1480–1484CrossRef

17.

Riley RW, Powell NB, Guilleminault C (1994) Obstructive sleep apnea and the hyoid: a revised surgical procedure. Otolaryngol Head Neck Surg 111(6):717–721CrossRef

18.

den Herder C, van Tinteren H, de Vries N (2005) Hyoidthyroidpexia: a surgical treatment for sleep apnea syndrome. Laryngoscope 115(4):740–745CrossRef

19.

Hamans E, Stuck BA, de Vries N, Boudewyns A, Devolder A, Verbraecken J, Van de Heyning P (2013) Hyoid expansion as a treatment for obstructive sleep apnea: a pilot study. Sleep Breath 17(1):195–201CrossRef

20.

Kaya N (1984) Sectioning the hyoid bone as a therapeutic approach for obstructive sleep apnea. Sleep 7(1):77–78CrossRef

21.

Karatayli-Ozgursoy S, Demireller A (2012) Hyoid suspension surgery with uppp for the treatment of hypopharyngeal airway obstruction in obstructive sleep apnea. Ear Nose Throat J 91(8):358–364CrossRef

22.

Bowden MT, Kezirian EJ, Utley D, Goode RL (2005) Outcomes of hyoid suspension for the treatment of obstructive sleep apnea. Arch Otolaryngol Head Neck Surg 131(5):440–445CrossRef

23.

Baisch A, Maurer JT, Hormann K (2006) The effect of hyoid suspension in a multilevel surgery concept for obstructive sleep apnea. Otolaryngol Head Neck Surg 134(5):856–861CrossRef

24.

Verse T, Baisch A, Maurer JT, Stuck BA, Hormann K (2006) Multilevel surgery for obstructive sleep apnea: short-term results. Otolaryngol Head Neck Surg 134(4):571–577CrossRef

25.

Richard W, Kox D, den Herder C, van Tinteren H, de Vries N (2007) One stage multilevel surgery (uvulopalatopharyngoplasty, hyoid suspension, radiofrequent ablation of the tongue base with/without genioglossus advancement), in obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol 264(4):439–444CrossRef

26.

Neruntarat C (2003) Hyoid myotomy with suspension under local anesthesia for obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol 260(5):286–290CrossRef

27.

Martinez-Garcia MA, Capote F, Campos-Rodriguez F, Lloberes P, Diaz de Atauri MJ, Somoza M, Masa JF, Gonzalez M, Sacristan L, Barbe F, Duran-Cantolla J, Aizpuru F, Manas E, Barreiro B, Mosteiro M, Cebrian JJ, de la Pena M, Garcia-Rio F, Maimo A, Zapater J, Hernandez C, Grau SanMarti N, Montserrat JM, Spanish Sleep N (2013) Effect of cpap on blood pressure in patients with obstructive sleep apnea and resistant hypertension: the hiparco randomized clinical trial. JAMA 310(22):2407–2415CrossRef

28.

Bratton DJ, Gaisl T, Wons AM, Kohler M (2015) Cpap vs mandibular advancement devices and blood pressure in patients with obstructive sleep apnea: a systematic review and meta-analysis. JAMA 314(21):2280–2293CrossRef

29.

Yang MC, Huang YC, Lan CC, Wu YK, Huang KF (2015) Beneficial effects of long-term cpap treatment on sleep quality and blood pressure in adherent subjects with obstructive sleep apnea. Respir Care 60(12):1810–1818CrossRef

30.

Pang KP, Pang EB, Pang KA, Vicini C, Chan YH, Rotenberg BW (2018) Upper airway surgery for obstructive sleep apnea reduces blood pressure. Laryngoscope 128(2):523–527CrossRef

31.

Robinson S, Chia M, Carney AS, Chawla S, Harris P, Esterman A (2009) Upper airway reconstructive surgery long-term quality-of-life outcomes compared with cpap for adult obstructive sleep apnea. Otolaryngol Head Neck Surg 141(2):257–263CrossRef

Title: The comparison of multilevel surgery (hyoid myotomy and suspension with uvulopalatopharyngoplasty) with CPAP in moderate to severe OSAS patients
Authors: Mei-Chen Yang
Yen-Bin Hsu
Ming-Ying Lan
Ming-Chin Lan
Publication date: 01-08-2020
Publisher: Springer Berlin Heidelberg
Keywords: Sleep Apnea
Polysomnography
Uvulopalatopharyngoplasty
Published in: European Archives of Oto-Rhino-Laryngology / Issue 8/2020
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-020-05951-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The comparison of multilevel surgery (hyoid myotomy and suspension with uvulopalatopharyngoplasty) with CPAP in moderate to severe OSAS patients

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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