title: Proposal of a presurgical algorithm for patients affected by obstructive sleep apnea syndrome.
abstract: OBJECTIVE
  To propose an algorithm for the preoperative management of patients with obstructive sleep apnea syndrome (OSAS) and review the surgical outcomes in such patients.
  
  
  METHODS
  This prospective cohort study involved 71 patients with OSAS who underwent presurgical upper airway endoscopy and cephalometry before being assigned to treatment categories based on the site(s) of obstruction, the pattern of collapse, the characteristics of the soft tissue, the air space between the base of the tongue and the posterior wall of the pharynx, and the severity of OSAS. Six months after surgery, they were followed up using polysomnography and the Epworth Sleepiness Scale. The pre- and postsurgical data were compared using a paired Student t test.
  
  
  RESULTS
  The mean preoperative apnea/hypopnea index of the 71 patients (61 male and 10 female) was 40.98 events/hour (range, 14.7 to 87.6 events/hr), and the mean postoperative apnea/hypopnea index was 13.96 events/hour (range, 0 to 20 events/hr). The difference was statistically significant (P < .001).
  
  
  CONCLUSIONS
  This algorithm was developed on the principle that every patient with OSAS should be considered individually. In the authors' opinion, taking into account the number, site(s), pattern, and degree of the collapse/obstruction is a reasonable means of ensuring the correct diagnosis and treatment.
authors.affiliation: Department of Maxillofacial Surgery, Azienda Ospedaliera Maggiore della Carità, University of Piemonte Orientale, "Amedeo Avogadro", Novara, Italy. mariangelagiarda@yahoo.it
authors.forename: Mariangela
authors.initials: M
authors.lastname: Giarda
authors.forename: Matteo
authors.initials: M
authors.lastname: Brucoli
authors.forename: Francesco
authors.initials: F
authors.lastname: Arcuri
authors.forename: Alberto
authors.initials: A
authors.lastname: Braghiroli
authors.forename: Paolo Aluffi
authors.initials: PA
authors.lastname: Valletti
authors.forename: Arnaldo
authors.initials: A
authors.lastname: Benech
mesh_terms: D000328:Adult; D000368:Aged; D000402:Airway Obstruction / Q000145:classification / Q000601:surgery; D000465:Algorithms; D002508:Cephalometry; D015331:Cohort Studies; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007013:Hypopharynx / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015508:Nasal Obstruction / Q000145:classification / Q000601:surgery; D009666:Nose / Q000473:pathology / Q000601:surgery; D009960:Oropharynx / Q000473:pathology; D056948:Orthognathic Surgical Procedures; D010347:Patient Care Planning; D010608:Pharyngeal Diseases / Q000145:classification / Q000601:surgery; D017286:Polysomnography; D011300:Preoperative Care; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000145:classification* / Q000601:surgery; D012894:Sleep Stages / Q000502:physiology; D014059:Tongue / Q000473:pathology; D016896:Treatment Outcome