Statistical model for postoperative apnea-hypopnea index after multilevel surgery for sleep-disordered breathing.

The objective of the study was to formulate a statistical model for postoperative apnea-hypopnea index (AHI) 3 and 12 months after multilevel surgery using the predictors preoperative AHI, body mass index (BMI) and age. The study design was a prospective cohort study. Data of 144 patients were collected prospectively 3 and 12 months after multilevel surgery for obstructive sleep apnea syndrome (OSAS) or upper airway resistance syndrome with excessive daytime sleepiness. The primary endpoint postoperative AHI and the secondary endpoint success according to the Sher criteria (postoperative AHI <20 h and >50% reduction of preoperative AHI) were modeled with multiple linear and logistic regression using the predictors preoperative AHI, BMI, age and the indicator whether the patient had undergone a tonsillectomy. Preoperative AHI and tonsillectomy had a highly significant positive influence on postoperative AHI after 3 months, whereas the influence of preoperative BMI was only marginally significant but numerically rather large. Age was not a significant decisive factor. The success according to the Sher criteria was highly significantly determined by the circumstance whether the patient had undergone a tonsillectomy, but not by the other predictors preoperative BMI or age. The responder rate with and without tonsillectomy was 58 and 19%, respectively. The odds ratio to be a responder if a tonsillectomy was conducted was 5.7. This study provides statistical models predicting postoperative AHI and success according to the Sher criteria after multilevel surgery for OSAS.

Therapy of snoring and obstructive sleep apnea using the Velumount palatal device.

OBJECTIVES: The aim of the present study is to investigate the efficacy of the Velumount device. METHODS: In a prospective cohort study 40 patients were examined with and without Velumount. The apnea-hypopnea index and average esophageal pressure were measured using nocturnal manometry of the upper airways, combined with respiratory polygraphy. The snoring index (1-10) and daytime sleepiness using the Epworth Sleepiness Scale were assessed by means of a questionnaire. RESULTS: Using Velumount the snoring index was reduced from on average 8.4 (SD +/- 1.3) to 3.7 (SD +/- 2.5), the Epworth Sleepiness Scale score from on average 7.9 (SD +/- 4.4) to 3.8 (SD +/- 3.4) and esophageal pressure from on average 14.8 cm H(2)O (SD +/- 6.7) to 11.2 cm H(2)O (SD +/- 6.4). In patients (n = 25) with obstructive sleep apnea, the average apnea-hypopnea index was 24.3 (SD +/- 10.1) without and 13.6 (SD +/- 12.2) with Velumount. All changes were highly significant. CONCLUSIONS: The Velumount device is effective for the treatment of snoring and obstructive sleep apnea. The effect is similar to that reported from uvulopalatopharyngoplasty.

Outcome of functional endonasal sinus surgery with and without CT-navigation.

INTRODUCTION: Computer-assisted surgery (CAS) has found widespread use in functional endonasal sinus surgery (FESS) over the past few years. The present study investigates if CAS leads to a better outcome in FESS. MATERIAL AND METHODS: All patients who underwent endonasal sphenoethmoidectomy were enrolled in a prospective, non-randomized case-control study. The procedures were done without CAS (group A) in 2003 and with CAS (group B) in 2004, using a Stryker navigation unit. Sixty-two patients (113 sphenoidectomies) were included in group A and 61 patients (109 sphenoidectomies) in group B. The underlying disease was recurrent chronic sinusitis or polyposis nasi in all patients except for inverted papilloma in one patient from group A and in two patients from group B. The follow-up period was 12 months. Symptom scores were assessed preoperatively and at 12 months postoperatively, using a questionnaire. A CT-scan was obtained in all patients preoperatively and at 6 months postoperatively. RESULTS: No significant difference was found between group A and B, neither with respect to symptom scores at 12 months postoperatively, nor in postoperative CT-scans. The operation strategy did not change by the introduction of CAS. The frontal sinuses were entered in group A and B in 59% and 64% of the patients, respectively. All parameters improved significantly postoperatively, compared to the preoperative values. As far as complications are concerned, two anterior orbital injuries and one retrobulbar haematoma occurred in group A and one postoperative lacrimal stenosis in group B. CONCLUSIONS: CAS does not lead to a better clinical outcome in FESS. Our data suggest that the rate of complications may be reduced using CAS. However, studies with a much larger number of patients would be necessary in order to definitely answer the question of whether CAS reduce complications in FESS.