Abstract
Objective: 1) Elucidate the efficacy of upperairway surgery for the treatment of obstructive sleep apnea/hypopnea syndrome(OSAHS). 2) Observe the change in polysomnography, continuous positive airway pressure (CPAP) therapy, and sleepiness following upper airway surgical intervention. 3) Objectively measure CPAP compliance using smart card CPAP devices.
Method: Surgical and clinical records were reviewed on patients (N =51) who underwent upper airway surgery for the treatment of moderate-severe OSAHS from January 2008 to June 2010 at an urban tertiary-care center. Outcome measurements recorded pre and postoperatively include BMI, Epworth sleepiness score, CPAP settings and compliance, and polysomnography.
Results: Data was collected and is currently undergoing analysis in a collaborative effort between the otolaryngology and pulmonology departments at our tertiary care center. A unique requirement for this study is the use of smart card CPAP devices on all patients allowing an objective measure of CPAP compliance. All patients underwent traditional uvulopalatopharyngoplasty (UPPP), lateral pharyngoplasty or expansion sphincter pharyngoplasty. Additionally, patients underwent turbinate reduction (N = 29), septoplasty (N = 20) and base of tongue reduction (N = 16). Initial analysis indicates a significant improvement in polysomnographic data and CPAP compliance. There does not appear to be problems associated with air-leak postoperatively.
Conclusion: Mucosa-sparing pharyngoplasty and multilevel upper airway surgery are effective treatment options for moderate-severe OSAHS. These surgical interventions can significantly reduce CPAP pressure settings and improve CPAP compliance. All patients undergoing CPAP therapy should be required to use smart card devices in order to objectively measure compliance.
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