Tongue base suspension and radiofrequency volume reduction: a comparison between 2 techniques for the treatment of sleep-disordered breathing.

PURPOSE: Lingual suspension (LS) and tongue base radio frequency volume reduction (RFVR) have been proposed as means of correcting the obstruction caused by the collapse or hypertrophy of the tongue base in patients having sleep-disordered breathing (SDB). The aim of this study was to evaluate and compare long-term results (6 months and 2 years) in a population of 24 patients having mild obstructive sleep apnea syndrome (OSAS), of whom 12 were treated with LS and 12 with RFVR. MATERIALS AND METHODS: The study included 24 patients having mild OSAS (apnea-hypopnea index between 10 and 20). All patients were assessed by means of the Epworth Sleepiness Scale, collection of anthropomorphic data, fiber-optic evaluation with Muller's maneuver, cephalometric assessment, and polysomnography. Lingual suspension was performed under general anesthesia with cervical cutaneous access. Radio frequency volume reduction was performed under local anesthesia with an Ellman Surgitron Dual RF unit (Ellman International, Inc., New York, NY), using a resterilizable bipolar terminal prototype. The same ear, nose, and throat examinations and polysomnography were carried out 6 months and 2 years after the surgical procedure. RESULTS: The results were evaluated according to the criteria by Sher (Sleep. 1996,19:156-177); after 6 months, the success percentage was 67% in patients treated with LS and 75% in those with RFVR. These percentages dropped to 42% in the first group and 33% in the second group after 24 months. CONCLUSIONS: Lingual suspension and RFVR are simple procedures that can be quickly performed and are well tolerated by patients. However, their effectiveness drops after 2 years. Our experience has therefore led us to conclude that the minimally invasive treatment for tongue base surgery can guarantee long-term results only in 42% and 33% of patients, respectively. Moreover, RFVR is preferable because it is simpler to perform and less invasive than LS, and it can be repeated over time.

Prevalence of patent foramen ovale in subjects with obstructive sleep apnea: a transcranial Doppler ultrasound study.

BACKGROUND: Under particular conditions a patent foramen ovale (PFO) can potentially give rise to ischemic stroke by means of paradoxic embolization. In obstructive sleep apnea syndrome (OSAS) right to left shunting (RLSh) can occur through PFO during periods of nocturnal apnea. Our study aimed to evaluate the prevalence of PFO diagnosed by means of transcranial Doppler (TcD) in subjects with OSAS. METHODS: Seventy-eight consecutive subjects with OSAS (mean age 53+/-12 years) and 89 normal controls (mean age 48+/-9 years) underwent TcD with intravenous application of agitated physiological saline solution. The test was performed on patients at rest and during Valsalva maneuver. RESULTS: PFO was present in 21 out of 78 patients with OSA (27%) and in 13 out of 89 control patients (15%). Seventeen out of 21 patients with OSA showed PFO only during Valsalva maneuver (85%) with respect to 12 out of 13 subjects of the control group (92%). Prevalence of PFO in OSAS was statistically different with respect to the control group (P<0.05). However, no statistically significant differences could be found for the prevalence of provocative-only shunting PFO with respect to already at rest shunting PFO in patients with OSAS with respect to the control group. CONCLUSIONS: Prevalence of PFO in subjects with OSA is significantly higher than in normal controls. The shunt is frequently present only during Valsalva maneuver.