Study for Clinical Efficacy of Sleep Surgery in Treatment of Patients with Moderate-Severe Obstructive Sleep Apnea

Lee, Woo Hyun; Oh, Seungyoung; Oh, Hoon; Park, Yong Kyun; Min, Sang Gi; Shin, Ji Ho; Kim, Hyun Jik

doi:2017.24.1.20

J Rhinol > Volume 24(1); 2017

Original Article

Journal of Rhinology 2017;24(1):20-25.
Published online May 31, 2017.
DOI: https://doi.org/10.18787/jr.2017.24.1.20

Study for Clinical Efficacy of Sleep Surgery in Treatment of Patients with Moderate-Severe Obstructive Sleep Apnea

Woo Hyun Lee, Seungyoung Oh, Hoon Oh, Yong Kyun Park, Sang Gi Min, Ji Ho Shin, Hyun Jik Kim

¹Department of Otolaryngology, National Police Hospital, Seoul, Korea.
²Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea.
³Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul, Korea. hyunjerry@snu.ac.kr

중등도-중증 폐쇄성수면무호흡증 환자의 수술결과에 관한 임상연구

이우현, 오승용, 오훈, 박용균, 민상기, 신지호, 김현직

국립경찰병원 이비인후과,¹ 중앙대학교 의과대학 이비인후-두경부외과학교실,² 서울대학교 의과대학 이비인후과학교실³

Abstract

Background and Objectives
Surgical treatment is considered as a secondary treatment option for obstructive sleep apnea (OSA). This study was performed to determine whether surgical treatment can be considered in patients with moderate-severe OSA as a treatment modality.
MATERIALS AND METHODS
A total of 127 patients with moderate-severe OSA were retrospectively enrolled. The anatomic narrowing sites were mainly evaluated using cephalometry and drug induced sleep endoscopy (DISE), and then multi-level surgeries were performed.
Results
Both uvula and soft palate were the most frequent narrowing sites and a total of 110 patients showed upper airway narrowing more than two anatomic structures. A total of 79 patients (62.1%) were categorized as responders and 48 patients (39.1%) were non-responders. After multi-level sleep surgeries, patients' subjective symptoms and sleep parameters were significantly improved. However, AHI was not considerably decreased. Non-responders to sleep surgeries showed relatively higher rates of severe OSA and body mass index. Tongue base narrowing, incomplete corrections of nasal pathologies and soft palate were significant factors for lower success rates.
Conclusion
We estimate that sleep surgery might be a therapeutic option for moderate to severe patients with OSA. A delicate pre-operative evaluation for upper airway narrowing is necessary to adapt sleep surgery to these patients.

Key Words: Obstructive sleep apnea;Sleep surgery;Drug induced sleep endoscopy;Severity;Efficacy