title: The Combination of Anatomy and Genioglossus Activity in Predicting the Outcomes of Velopharyngeal Surgery.
abstract: Objective This study aims to evaluate the combination of genioglossus (GG) activity and anatomical characteristics in predicting outcomes of velopharyngeal surgery in patients with obstructive sleep apnea (OSA). Study Design Case series with planned data collection. Setting Sleep medical center. Subjects and Methods Forty patients with OSA underwent overnight polysomnography with synchronous genioglossus electromyography (GGEMG) using intraoral electrodes. The upper airway anatomy was evaluated by 3-dimensional computed tomography in patients with OSA. All patients received the same type of velopharyngeal surgery, consisting of revised uvulopalatopharyngoplasty with uvula preservation and concurrent transpalatal advancement pharyngoplasty. We followed up all patients using polysomnography for at least 3 months postoperatively. Results Twenty-five patients (62.50%) were responders, and 15 patients (37.50%) were nonresponders. The decreased apnea-hypopnea index was significantly positively correlated to the sleep onset GGEMG ( P = .006) but was negatively correlated to the change in GGEMG ( P = .013) and tonic GGEMG ( P = .018). Multiple regression analysis revealed that the minimal cross-sectional airway area at the velopharynx (VmCSA) (odds ratio [OR], 1.760; P = .019) and the sleep onset GGEMG (OR, 0.322; P = .043) were significant predictors for surgical outcomes. Combined the two predictors, the area under the ROC curve was 0.901 (OR, 0.789; P = .001) for surgical success, was more valuable than any one predictor. The area under the ROC curve with GGEMG was 0.843, VmCSA was 0.848. Conclusions The combination of sleep onset GGEMG and VmCSA can predict the outcome of velopharyngeal surgery in patients with OSA.
authors.affiliation: 1 Department of Otorhinolaryngology, The Second Affiliated Hospital, School of Medicine, Zheijiang University, Zhejiang, China.|2 Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
authors.forename: Di
authors.initials: D
authors.lastname: Zhao
authors.affiliation: 2 Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.|3 University of California, San Diego, Division of Pulmonary and Critical Care Medicine, La Jolla, California, USA.
authors.forename: YanRu
authors.initials: Y
authors.lastname: Li
authors.affiliation: 4 Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
authors.forename: JunFang
authors.initials: J
authors.lastname: Xian
authors.affiliation: 2 Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
authors.forename: Yue
authors.initials: Y
authors.lastname: Qu
authors.affiliation: 2 Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Cao
authors.affiliation: 5 Department of Otolaryngology, Head and Neck Surgery, Beijing Tsinghua Chang Gung Hospital Beijing, China.
authors.forename: JingYing
authors.initials: J
authors.lastname: Ye
mesh_terms: D000328:Adult; D004576:Electromyography; D006801:Humans; D008297:Male; D010160:Palate, Soft / Q000601:surgery*; D010614:Pharynx / Q000601:surgery*; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D014059:Tongue / Q000033:anatomy & histology / Q000502:physiology; D016896:Treatment Outcome
keywords: genioglossus activity; intraoral electrode; obstructive sleep apnea; velopharyngeal surgery