Treatment of Obstructive Sleep Apnea with Multiple Surgeries

Abstract

Objective: 1) Be able to determine the effects of multiple surgeries in the treatment of moderate and severe obstructive sleep apnea. 2) Confirm the importance of identifying the sites of obstruction in the treatment of obstructive sleep apnea.

Method: A retrospective review of a prospective dataset of 40 patients with moderate and severe obstructive sleep apnea who had undergone multiple surgeries. Patients studied underwent palatal surgery with or without nasal and tongue base surgery. Charts between 1997 and 2011 were reviewed and the surgical results were determined.

Results: Thirty-two patients (80%) underwent UPPP, associated with midline glossectomy in 26 patients (65%). Five patients (12.5%) underwent expansion sphincter pharyngoplasty, associated with midline glossectomy in 1 patient (2.5%). One patient (2.5%) underwent lateral pharyngoplasty. At least some improvement occurred in 4 patients (40%) in the moderate OSAS group (n = 10), but 4 patients (40%) in this group showed a slight (nonsignificant) worsening in mean apnea/hypopnea index. In the severe OSAS group (n = 30) 25 patients (83.3%) showed significant improvement (decrease in mean number of events per hour; P < .0001). Minimum oxygen saturation improved in the moderate and severe OSAS groups.

Conclusion: In our study, as indicated by the apnea/hypopnea index, the use of multiple procedures appears to have better results in severe OSAS than in moderate OSAS. The results of surgical procedures are difficult to predict. Lack of success is usually due to failure to identify all sites of obstruction.