Polysomnography early after uvulopalatopharyngoplasty as a predictor of late postoperative results.
We performed nocturnal diagnostic polysomnography (PSG 1), PSG early after UPPP on the second to the fifth postoperative night (PSG 2) and PSG late after UPPP (PSG 3) six or more weeks after surgery, on 15 male patients with obstructive sleep-disordered breathing. On PSG 1, the A + H/I for the group was 66.6 +/- 8.8 (mean +/- SE). During non-REM sleep the A + H/I on PSG 3 (29 +/- 10) was lower than it was on PSG 2 (54.3 +/- 11.3) (p = 0.004) and lower than that on PSG 1 (70.8 +/- 10.3) (p = 0.003). Similarly, during non-REM sleep, the AI on PSG 3 (16.1 +/- 7.4) was less than that on PSG 2 (39.1 +/- 10.4) (p = 0.003) and less than that on PSG 1 (41.7 +/- 9.6) (p = 0.015). In the eight patients in whom REM sleep was recorded on all three PSGs, there was no difference with respect to A + H/I or AI. The nadir of SaO2 during non-REM sleep was higher during PSG 3 than during PSG 1 (p = 0.002), but not different from that on PSG 2. There were no differences among the three studies with respect to REM-related nadirs of SaO2; however, there was a good deal of interindividual variability across the three PSGs. In general, individuals with satisfactory amelioration of sleep-disordered breathing on PSG 2 demonstrated similar improvement on PSG 3. Patients who did not have a substantial improvement in the early postoperative period often had improvement on PSG 3, but there was a good deal of interindividual variability in this regard. We conclude that PSG within a few days following UPPP is warranted in patients with obstructive sleep-disordered breathing to determine if there has been worsening of upper airway function or oxygenation (or both) during sleep in the early postoperative period. A satisfactory result early after UPPP suggests that a late postoperative PSG is unnecessary, with savings in cost and the convenience.
Sanders
M H
MH
Department of Otolaryngology, University of Pittsburgh School of Medicine.
Costantino
J P
JP
Johnson
J T
JT
D000328:Adult; D002245:Carbon Dioxide / Q000097:blood; D006801:Humans; D008297:Male; D010100:Oxygen / Q000097:blood; D010160:Palate, Soft / Q000601:surgery*; D010614:Pharynx / Q000601:surgery*; D011379:Prognosis; D012119:Respiration; D012891:Sleep Apnea Syndromes / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D012895:Sleep, REM / Q000502:physiology; D014609:Uvula / Q000601:surgery*
D002245:Carbon Dioxide; D010100:Oxygen