Sphincter pharyngoplasty as a treatment of velopharyngeal incompetence in young people: a prospective evaluation of effects on sleep structure and sleep respiratory disturbances.
BACKGROUND
Sphincter pharyngoplasty (SP) appears to be the more "physiologic" surgical technique to treat velopharyngeal incompetence (VPI). This procedure creates a dynamic sphincter of variable diameter and keeps the flexibility of the soft palate. SP also induces velopharyngeal size reduction, mainly in the transverse diameter, which may cause upper airway (UA) occlusions during sleep.


OBJECTIVE
To prospectively evaluate the effects of SP by a modified Orticochea procedure on sleep structure and sleep respiratory disturbances.


METHODS
Polysomnographic studies before and after surgery in 17 consecutive patients treated by a modified Orticochea procedure SP for VPI.


RESULTS
For the whole group, SP did not induce significant impairment of apnea-hypopnea index or nocturnal oxygen saturation. Slow-wave sleep (SWS) was significantly reduced after surgery (25 +/- 9% of total sleep time [TST] vs 28 +/- 9% of TST before SP [p = 0.04]). Following surgery, there was a trend for an increase in the microarousal index) (p = 0.09) and more specifically in respiratory-related microarousals.


CONCLUSIONS
SP, although creating a clinically obvious reduction of velopharyngeal diameter, generally did not lead to the occurrence of an obstructive sleep apnea syndrome. However, we found a significant reduction of SWS quantity and a trend toward an increase in the number of cortical microarousals. These findings suggest that the reduction of UA diameter associated with the surgical technique leads to increases in respiratory effort sufficient to induce sleep fragmentation and SWS reduction, even in the absence of apneas or hypopneas.
Department of Respiratory Medicine, Intensive Care Unit and Sleep Laboratory, HP2 Laboratory, University Hospital, Grenoble, France.
Christel
C
Saint Raymond
Georges
G
Bettega
Christel
C
Deschaux
Jacques
J
Lebeau
Bernard
B
Raphael
Patrick
P
Lévy
Jean-Louis
JL
Pépin
D000293:Adolescent; D002972:Cleft Palate / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D013517:Otorhinolaryngologic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D010614:Pharynx / Q000601:surgery*; D017286:Polysomnography; D011183:Postoperative Complications; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000209:etiology; D014681:Velopharyngeal Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*