RESUMEN
Objective To investigate the changes of uvulopalatopharyngoplasty on the auditory function in adult patients with severe obstructive sleep apnea-hypopnea syndrome (OSAHS).The possible mechanism of hypoxemia was analyzed,and hypercapnia might affect auditory function and the effect of operation to hearing was improved.Methods A total of 82 adult patients who were made a diagnosis by polysomnography (PSG) with severe OSAHS had been diagnosed by pure tone audiometry,tympa-nometry,auditory brainstem responses (ABR),and otoacoustic emissions (OAE) before and 6 months after surgical treatments.The control group included 43 non-snoring healthy people through the same line of the above test.Results (1)Among 82 patients who underwent uvulopalatopharyngoplasty,symptoms were resolved in 51 patients,significantly improved in 24 patients,and somewhat improved in7 patients at 6 months followed-up,yielding a total effective rate of 100％.(2)There were no significant differences in hearing threshold across 250 to 4 000 Hz on pure tone audiometry between OSAHS and control groups (P ＞ 0.05),although hearing thresholds at high frequencies showed significant differences (P ＜ 0.05).(3)The latencies of ABR waves Ⅰ and Ⅴ in the OSAHS group were significantly longer than control group (P ＜ 0.05).The interpeak lantency intervals of wave Ⅲ ～ Ⅴ in patients with OSAHS were longer than that in the control group (P ＜ 0.05).No significant difference was showed before and after surgery (P ＞ 0.05).(4)Distortion product otoacoustic emission (DPOAE) detection rate and amplitudes at all frequencies were poorer in OSAHS group before surgery compared with the control group (P ＜ 0.05),and significant changes were found after surgical treatments (P ＜ 0.05).Conclusions OSAHS can impair auditory function,probably from chronic hypoxia,which can be improved by surgical treatment in adult patients with severe OSAHS.
RESUMEN
Existem várias modalidades cirúrgicas utilizadas no tratamento da síndrome de apneia obstrutiva do sono (SAOS). Esta afecção pode causar sonolência diurna excessiva, bem como aumentar o risco de morbidade e mortalidade cardiovascular. Os doentes que não aderem ao tratamento médico convencional são frequentemente encaminhados para tratamento por procedimento cirúrgico. OBJETIVO: Recapitular e descrever as principais opções cirúrgicas, do foro otorrinolaringológico, disponíveis para o tratamento de SAOS, bem como apresentar os resultados em termos de melhoria do índice de apneia/hipopneia e benefícios sobre a mortalidade. MÉTODO: Revisão bibliográfica acerca dos diferentes tratamentos cirúrgicos, tanto de tecidos moles como de tecidos esqueléticos. Foram apenas incluídos os artigos que apresentavam as descrições originais. Revisões sistemáticas e artigos que apresentavam resultados funcionais das cirurgias também foram incluídos nesta análise. RESULTADOS: Vinte e nove modalidades cirúrgicas foram identificadas, tendo sido apresentados os autores dos artigos originais e o seu ano de descrição. Foram, ainda, apresentados dados polissonográficos relativos ao índice de apneia, índice de apneia/hipopneia e dados sobre a mortalidade. CONCLUSÃO: Existe uma grande heterogeneidade nos resultados da cirurgia no tratamento de SAOS. A combinação de diversos procedimentos cirúrgicos parece melhorar as taxas de sucesso bem como as taxas de cura. A tecnologia neste domínio evolui rapidamente, e os cirurgiões que se dedicam a esta afecções devem manter-se atualizados e integrar equipes multidisciplinares, a fim de maximizar os resultados. .
There are several surgical treatment modalities utilized for obstructive sleep apnea syndrome (OSAS). OSAS can cause excessive daytime sleepiness as well as cardiovascular morbidity and mortality. Patients who fail medical management often seek surgical treatment. OBJECTIVE: This paper reviews surgical treatment options for obstructive sleep apnea syndrome to include original descriptions as well as outcomes for snoring, apnea-hypopnea indices, and mortality benefits. METHOD: A literature review was performed for OSAS surgical treatment options for soft tissue and skeletal surgeries. Articles with the original descriptions and surgical reviews are included for each procedure. RESULTS: A total of twenty-eight surgical treatment modalities for OSAS were identified. Original article authors and year of description were obtained and presented. Polysomnographic data for apnea indices, apnea-hypopnea indices and mortality are presented. CONCLUSION: There is a large amount of variability in outcomes for sleep surgeries, however, in order to maximize success and cure rates, multiple procedures are most often necessary. Sleep surgeons must get familiar with modern surgical concepts and techniques, and participate in multi-disciplinary care in order to maximize treatment outcomes. .