Outcomes of upper airway reconstructive surgery for moderate to severe obstructive sleep apnea syndrome based on upper airway pressure measurements

Objective: To assess the effect of upper airway reconstructive surgery for moderate to severe obstructive sleep apnea-hypopnea syndrome (OSAHS) with the obstructive sites determined by pressure measurements, and to evaluate the clinical value of upper airway manometry in localizing the obstructive sites.

Methods: Fifty-one moderate to severe OSAHS patients were examined using whole night recording, including airway continuous pressure measurements (ApneaGraph, MRA-Medical Ltd, UK). ApneaGraph (AG) transducer catheter contains two pressure and two temperature sensors used for obstruction site determination and detection of apnoeic events during sleep. Obstructive sites were divided into upper (retropalatal region) and lower level (retroglossal region). The lower limit of obstruction was determined by AG pressure pattern. Using constituent ratio to reflect the obstructive proportion of different levels. All patients were divided into two groups (retropalatal or retroglossal) according to the primary obstructive level. The patients of retropalatal group were treated with modified uvulopalatopharyngoplasty (UPPP), or plus hard palate shortening. The patients of retroglossal group underwent tongue and palatal surgical procedures such as UPPP, hyoid suspension, radiofrequency ablation of tongue base, genioglossus advancement etc. All patients were followed-up at least 6 months using Apneagraph. Clinical outcomes included the Epworth sleeping scale (ESS), apnea-hypopnea index (AHI) and lowest arterial oxygen saturation (LSaO2).

Results: Five patients had moderate OSAHS and 46 were severe. Four patients had experienced UPPP failures. The ESS reduced from average 17.6 ± 4.7 to 4.3 ± 4.3 (x(-) ± s, t = 15.195, P < 0.001). The AHI reduced from average 52.4 ± 17.5 to 16.3 ± 18.2 (t = 10.873, P < 0.001). The LSaO2 increased from 0.706 ± 0.099 (x(-) ± s) to 0.823 ± 0.092 (t = -8.396, P < 0.001). The success was defined as a ≥ 50 percent reduction and final apnea-hypopnea index < 20/h, the total success rate was 76.5%. Retropalatal group had 27 patients and 24 cases were in retroglossal group.Their success rate were 81.5% and 75.0% respectively.

Conclusions: The upper airway pressure measurements can identify the level of obstruction accurately and prove to be effective in the treatment of OSAHS.