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Treatment of Obstructive Sleep Apnea-Hypopnea Syndrome With Combined Uvulopalatopharyngoplasty and Midline Glossectomy: Outcomes From a 5-Year Study

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Abstract:

BACKGROUND: The aim of this retrospective long-term follow-up study was to assess 5-year outcomes after combined uvulopalatopharyngoplasty (UPPP) and midline glossectomy surgery for the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS). METHODS: A total of 34 subjects with OSAHS with combinatory obstructions of posterior soft palate and posterior tongue area who underwent combined midline glossectomy and UPPP were successfully followed for 5 years to examine the therapeutic effect of treatment. All subjects were of Friedman stage II or III and had major stenoses at the base of the tongue. The apnea-hypopnea index (AHI), and mean lowest SpO2 were measured preoperatively and postoperatively to assess therapeutic efficacy. RESULTS: The mean preoperative AHI was 56.0 ± 8.4 episodes/h, while the mean lowest SpO2 was 62.1 ± 10.6%. AHI and mean lowest SpO2 were significantly increased and decreased, respectively, from preoperative levels at each follow-up point after surgery, up to 5 years (P < .05). The average widened pharyngeal space after surgery was 42 mm2. At 6 months, surgery was classified as being curative in 27/34 (79.41%) of subjects, and markedly effective or effective in the remaining subjects. At 5 years, surgery was classified as being curative in 7/34 (20.59%) subjects, markedly effective or effective in 25/34 (73.53%) subjects, and not effective in 2/34 (5.88%) subjects. Five years after surgery the average body mass index for the subjects who were not cured was slightly higher than those who were cured, but the difference was not statistically significant (31.3 ± 3.7 kg/m2 vs 29.7 ± 3.6 kg/m2, P = .29). Subjects who were cured had lower supine AHI values than those who were not cured (2-year postoperative AHI 36.8 ± 9.2 episodes/h vs 43.8 ± 6.9 episodes/h, P = .03, 5-year post-operation AHI 32.1 ± 7.6 episodes/h vs 41.7 ± 8.2 episodes/h, P = .006). CONCLUSIONS: These findings suggest that combined midline glossectomy and UPPP can be an effective treatment for subjects with Friedman stage II or III OSAHS and substantial stenosis around the base of the tongue.

Keywords: apnea-hypopnea index; midline glossectomy; obstructive sleep apnea; surgery; uvulopalatopharyngoplasty

Document Type: Research Article

DOI: http://dx.doi.org/10.4187/respcare.01695

Affiliations: Department of Otolaryngology, Head and Neck Surgery, Second Affiliated Hospital, Xi’an Jiaotong University School of Medicine, Xi’an, PR China

Publication date: December 1, 2012

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