To retrospectively study the effects of minimally invasive single-stage multilevel surgery (MISS MLS) for treating patients with obstructive sleep apnea/hypopnea syndrome (OSA) on quality of life (QOL).
Methods:
All OSA patients with multilevel obstruction who failed or refused continuous positive airway pressure (CPAP) treatment and then underwent Pillar implants and temperature-controlled radiofrequency of the base of tongue (RFBOT) were enrolled. The subjective symptoms and QOL (SF-36 Taiwan Standard Version 1.0) parameters were collected preoperatively and a minimum of 3 months postoperatively. Postoperative morbidity and complications were also recorded.
Results:
Thirty-seven patients (30 men, 7 women; mean age = 46.8 years; mean BMI = 23.9 kg/m2) were enrolled. The mean Epworth Sleepiness Scale changed from 12 ± 4.3 to 10.6 ± 4.3 (P = .004, Wilcoxon signed-rank test). The mean snoring visual analog scale reduced from 9.5 ± 1.3 to 4.0 ± 2.0 (P < .0001). The mean score of SF-36 increased from 65.5 ± 19.6 to 75.2 ± 16.7 (P = .001). The SF-36 subscales showed statistically significant changes, especially in bodily pain, role-emotional, and general health.
Conclusion:
The study demonstrated that MISS MLS was effective on QOL in selected patients for treating OSA patients who are unresponsive to conservative OSA therapy.
FriedmanMIbrahimHLeeGJosephNJ.Combined uvulopalatopharyngoplasty and radiofrequency tongue base reduction for treatment of obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surg. 2003;129(6):611-621.
2.
KaoYHShnayderYLeeKC.The efficacy of anatomically based multilevel surgery for obstructive sleep apnea. Otolaryngol Head Neck Surg. 2003;129(4):327-335.
3.
LinHCFriedmanMChangHWSuMCWilsonM.Z-palatopharyngoplasty plus radiofrequency tongue base reduction for moderate/severe obstructive sleep apnea/hypopnea syndrome. Acta Otolaryngol. 2010;130(9):1070-1076.
4.
LinHCFriedmanMChangHWGurpinarB.The efficacy of multilevel surgery of the upper airway in adults with obstructive sleep apnea/hypopnea syndrome. Laryngoscope. 2008;118(5):902-908.
5.
StewardDLWeaverEMWoodsonBT.A comparison of radiofrequency treatment schemes for obstructive sleep apnea syndrome. Otolaryngol Head Neck Surg. 2004;130(5):579-585.
6.
StewardDLHuntleyTCWoodsonBTSurdulescuV.Palate implants for obstructive sleep apnea: multi-institution, randomized, placebo-controlled study. Otolaryngol Head Neck Surg. 2008;139(4):506-510.
7.
FriedmanMSchalchPLinHCKakodkarKAJosephNJMazloomN.Palatal implants for the treatment of snoring and obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surg. 2008;138(2):209-216.
LinHCFriedmanMChangHWet al. Minimally invasive single-stage multilevel surgery for OSA in Asian patients. JAMA Otolaryngol Head Neck Surg. 2017;143(2):147-154.
10.
KezirianEJWeaverEMCriswellMAde VriesNWoodsonBTPiccirilloJF.Reporting results of obstructive sleep apnea syndrome surgery trials. Otolaryngol Head Neck Surg. 2011;144(4):496-499.
11.
FlemingTRDeMetsDL.Surrogate end points in clinical trials: are we being misled?Ann Intern Med. 1996;125(7):605-613.
12.
ListMAStracksJ. Evaluation of quality of life in patients definitively treated for squamous carcinoma of the head and neck. Curr Opin Oncol. 200;12(3):215-220.
13.
RechtschaffenAKalesA.A Manual of standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects. Los Angeles: BIS/BRI University of California, Los Angeles; 1968.
14.
KushidaCALittnerMRMorgenthalerTet al. Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep. 2005;28(4):499-521.
15.
American Academy of Sleep Medicine. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The report of an American Academy of Sleep Medicine Task Force. Sleep. 1999;22(5):667-689.
LinHCLinPWSuCYChangHW.Radiofrequency for the treatment of allergic rhinitis refractory to medical therapy. Laryngoscope. 2003;113(4):673-678.
18.
LinHCLinPWFriedmanMet al. Long-term results of radiofrequency turbinoplasty for allergic rhinitis refractory to medical therapy. Arch Otolaryngol Head Neck Surg. 2010;136(9):892-895.
19.
FriedmanMVidyasagarRBliznikasDJosephNJ.Patient selection and efficacy of pillar implant technique for treatment of snoring and obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surg. 2006;134(2):187-196.
20.
LinHCFriedmanMChangHWet al. Effects of pillar implants for sleep-related breathing disorders on middle ear function. Eur Arch Otorhinolaryngol. 2013;270(8):2339-2343.
21.
JohnsMW.Daytime sleepiness, snoring, and obstructive sleep apnea. The Epworth Sleepiness Scale. Chest. 1993;103(1):30-36.
22.
LuJFTsengHMTsaiYJ.Assessment of health-related quality of life in Taiwan (I): development and psychometric testing of SF-36 Taiwan version [in Chinese]. Taiwan Journal of Public Health. 2003;22(6):501-511.
23.
TsengHMLuJFTsaiYJ.Assessment of health-related quality of life in Taiwan (Ⅱ): norming and validation of SF-36 Taiwan version [in Chinese]. Taiwan Journal of Public Health. 2003;22(6):512-518.
24.
FriedmanMSchalchPLinHCMazloomNNeidichMJosephNJ.Functional endoscopic dilatation of the sinuses: patient satisfaction, postoperative pain, and cost. Am J Rhinol. 2008;22(2):204-209.
25.
StewardDLWeaverEMWoodsonBT.Multilevel temperature-controlled radiofrequency for obstructive sleep apnea: extended follow-up. Otolaryngol Head Neck Surg. 2005;132(4):630-635.
26.
FriedmanMSchalchPJosephNJ.Palatal stiffening after failed uvulopalatopharyngoplasty with the Pillar Implant System. Laryngoscope. 2006;116(11):1956-1961.
27.
TamSWoodsonBTRotenbergB.Outcome measurements in obstructive sleep apnea: beyond the apnea-hypopnea index. Laryngoscope. 2014;124(1):337-343.
28.
WeaverTE.Outcome measurement in sleep medicine practice and research. Part 1: assessment of symptoms, subjective and objective daytime sleepiness, health-related quality of life and functional status. Sleep Med Rev. 2001;5(2):103-128.
29.
WeaverEMWoodsonBTStewardDL.Polysomnography indexes are discordant with quality of life, symptoms, and reaction times in sleep apnea patients. Otolaryngol Head Neck Surg. 2005;132(2):255-262.
30.
NietoFJYoungTBLindBKet al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA. 2000;283(14):1829-1836.
31.
PeppardPEYoungTPaltaMSkatrudJ.Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 200;342(19):1378-1384.
32.
StewardDL.Effectiveness of multilevel (tongue and palate) radiofrequency tissue ablation for patients with obstructive sleep apnea syndrome. Laryngoscope. 2004;114(12):2073-2084.
33.
FischerYKhanMMannWJ.Multilevel temperature-controlled radiofrequency therapy of soft palate, base of tongue, and tonsils in adults with obstructive sleep apnea. Laryngoscope. 2003;113(10):1786-1791.
34.
StuckBAStarzakKHeinGVerseTHörmannKMaurerJT.Combined radiofrequency surgery of the tongue base and soft palate in obstructive sleep apnoea. Acta Otolaryngol. 2004:124(7):827-832.
35.
CeylanKEmirHKizilkayaZet al. First-choice treatment in mild to moderate obstructive sleep apnea: single-stage, multilevel, temperature-controlled radiofrequency tissue volume reduction or nasal continuous positive airway pressure. Arch Otolaryngol Head Neck Surg. 2009;135(9):915-919.
36.
NeruntaratCChantapantS.Radiofrequency surgery for the treatment of obstructive sleep apnea: short-term and long-term results. Otolaryngol Head Neck Surg. 2009;141(6):722-726.
37.
BrazierJEHarperRJonesNMet al. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ. 1992;305(6864):160-164.
