Comparison of surgery and nasal continuous positive airway pressure treatment for obstructive sleep apnea syndrome.
Uvulopalatopharyngoplasty (UPPP) and nasal continuous positive airway pressure (n-CPAP) are used for the treatment of obstructive sleep apnea syndrome (OSAS). Although OSAS results from an abnormality of the pharynx, very little research has been carried out regarding the selection of UPPP or n-CPAP according to the type of abnormality. We performed n-CPAP titration before and after surgery, compared the treatment methods and evaluated the effect of the medical therapy. A sleep polygraph was recorded on the first night of admission and patients diagnosed with OSAS underwent n-CPAP titration on the second night. The blocked region was identified by means of endoscopic examination. A couple of months after surgery, polysomnography was repeated to determine the effect of surgery and the pressure level during n-CPAP forpatients who showed < 50% improvement in the apnea-hypopnea index. The results of surgery were poor in cases revealed by endoscopy to have the circumferential type of obstruction, but good for the soft palate and tonsil types. When endoscopic examinations were performed in conjunction with n-CPAP, the treatment was observed to act on the pharynx and to expand the airway in all cases Combined medical treatments were effective in cases where n-CPAP alone was ineffective due to high pressure.
Department of Otolaryngology, The Second Affiliated Hospital, Fujita Health University School of Medicine, Nagoya, Japan. febru@k3.dion.ne.jp
Chikaya
C
Hattori
Tadao
T
Nishimura
Kenji
K
Kawakatsu
Munenori
M
Hayakawa
Kenji
K
Suzuki
D000328:Adult; D000368:Aged; D001784:Blood Gas Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010159:Palate / Q000503:physiopathology / Q000601:surgery; D010614:Pharynx / Q000503:physiopathology / Q000601:surgery; D017286:Polysomnography; D011175:Positive-Pressure Respiration; D019651:Plastic Surgery Procedures; D012129:Respiratory Function Tests; D020181:Sleep Apnea, Obstructive / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D014609:Uvula / Q000503:physiopathology / Q000601:surgery