[Multi-level surgery for obstructive sleep apnea. Preliminary objective results].
BACKGROUND
Nasal continuous positive airway pressure (nCPAP) ventilation is the gold standard in the treatment of obstructive sleep apnea (OSA). Unfortunately nCPAP does not exceed long-term compliance rates of much more than 60 percent. Therefore, surgical strategies are of growing interest in this field. Today, so called multi-level surgeries are favored which combine at least one surgical procedure on both the velopharyngeal and the retrolingual section of the upper airway. The Mannheim concept combines at least one surgical procedure to the soft palate (UPPP or Uvulaflap) inclusive tonsillectomy and a hyoid suspension and/or a radiofrequency procedure on the base of tongue.


METHODS
In between July 2000 and February 2003, 139 patients with OSA were included in the protocol. By now 46 patients finished the follow-up. Mean age was 51.9 years, the mean body mass index was 28.5 kg m (- 2). All patients underwent as well preoperatively as postoperatively a fully attended polysomnography in the sleep lab using standard criteria. Daytime sleepiness was assessed using the Epworth Sleepiness Scale (ESS).


RESULTS
Before surgery the mean apnea-hypopnea-index (AHI) was 36.5 +/- 22.2, the mean ESS score was 10.4. Postoperatively the mean AHI decreased to 24.9 +/- 21.6 (p < 0.01) and the mean ESS score to 7.1 (p < 0.05). After surgery 39.1 % of the subjects were regarded as cured (reduction of AHI > or = 50 % and below 15). Another 30.4 % were substantially improved (reduction of AHI > 20 %). Altogether 69.6 % of the patients were counted as responders. Cure rates decreased with increasing AHI and BMI. The hyoid suspension showed a positive effect on the treatment success.


CONCLUSIONS
The presented concept shows inferior success rates than other more invasive concepts. This might be due to the abandonment of the mandibular osteotomy with genioglossus advancement.
Universitäts-HNO-Klinik, Mannheim. thomas.verse@hno.ma.uni-heidelberg.de
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D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003131:Combined Modality Therapy; D003627:Data Interpretation, Statistical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010160:Palate, Soft / Q000601:surgery; D010614:Pharynx / Q000601:surgery; D017286:Polysomnography; D011183:Postoperative Complications / Q000209:etiology; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000601:surgery*; D014059:Tongue / Q000601:surgery; D016896:Treatment Outcome