[Preoperative overnight airway pressure measurement for predicting the outcome of revised uvulopalatopharyngoplasty].
OBJECTIVE
The distribution of upper airway obstruction sites can be identified quantitatively and dynamically with continuous airway pressure measurements in obstructive sleep apnea hypopnea syndrome ( OSAHS) patients. Its value as a clinical predictor for the outcome of revised uvulopalatopharyngoplasty was evaluated.


METHODS
The upper airway obstruction sites (transpalatal level, tongue base or hypolarynx level) were determined preoperatively with overnight upper airway pressure monitoring and concurrent polysomnography (PSG). Of one's total amount of obstructive events, the proportion of apnea/hypopnea events located at Transpalatal level was quantified as contribution of transpalatal obstruction. Of all OSAHS patients, 26 males and 1 female underwent revised uvulopalatopharyngoplasty (2 had same stage transpalatal advancement pharyngoplasty) and had follow-up PSG 6. 33 +/- 0.84 months after surgery. The relationship of transpalatal obstruction proportion, age, tonsil size and body mass index (BMI) and the reduction in apnoea hypopnea index (AHI) was analyzed.


RESULTS
The AHI (times/hr) of 27 subjects decreased from 63.9 +/- 20.7 to 28.4 +/- 25.4. The response rate was 51.9% (defined as AHI reduction over 50%). Correlation between the transpalatal obstruction proportion and the AHI reduction percentage was significant (r = 0.609), so was the degree of the tonsil size (r = 0.511). The proportion of tongue base level obstruction showed a negative correlation for the AHI reduction. Patients with oropharynx obstruction percentage > or = 70% had a success rate of 90% and all patients with oropharynx obstruction percentage <60% responded poorly to the operation. The regression model showed distribution of obstructive sites, along with tonsil size and other PSG parameters could predict 66.7% of the postoperative AHI of transpalatal level surgery (F = 6.701, P = 0.001) .


CONCLUSIONS
Contribution of transpalatal level obstruction has significant predictive value to the outcome of transpalatal level surgery in OSAHS patients.
Han
De-min
DM
Department of Otorhinolaryngology-Head and Neck Surgery, Affiliated Beijing Tongren Hospital, Capital University of Medical Sciences, Beijing 100730, China. handm@trhos.com
Ye
Jing-ying
JY
Li
Yan-ru
YR
Zhang
Yu-huan
YH
Wang
Xiao-yi
XY
Yin
Guo-ping
GP
Ding
Xiu
X
D000328:Adult; D000403:Airway Resistance; D002972:Cleft Palate / Q000601:surgery; D004947:Esophagus / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010159:Palate / Q000601:surgery; D010614:Pharynx / Q000601:surgery; D011237:Predictive Value of Tests; D011312:Pressure; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology* / Q000601:surgery; D016896:Treatment Outcome; D014609:Uvula / Q000601:surgery; D055815:Young Adult