Analysis of the cause of retrolingual obstruction in patients with moderate-severe obstructive sleep apnea.

PURPOSE: To evaluate the percentage of obstructive sleep apnea (OSA) patients with retrolingual obstruction in all moderate-severe OSA patients and the proportions of different causes in all moderate-severe OSA patients with retrolingual obstruction and to discuss the accuracy of the Friedman tongue position (FTP) and retrolingual cross-sectional area (RCSA) in assessing the retrolingual obstruction. METHODS: Two hundred and twenty moderate-severe OSA patients were enrolled. After retrolingual obstruction was diagnosed, the percentage of OSA patients with retrolingual obstruction in all moderate-severe OSA patients was calculated. After that, the different causes of retrolingual obstruction were diagnosed based on different diagnostic criteria, and the proportions of different causes in all moderate-severe OSA patients with retrolingual obstruction were calculated. Finally, the correlations between FTP, RCSA, and apnea-hypopnea index after nasopharyngeal tube insertion (NPT-AHI) were analyzed, and the proportions of different causes of retrolingual obstruction based on different FTP and RCSA were observed. RESULTS: There were 128 patients with retrolingual obstruction, accounting for 58.2% of all moderate-severe OSA patients. In 128 patients with retrolingual obstruction, the proportions of glossoptosis (48.4%), palatal tonsil hypertrophy (28.1%), and lingual hypertrophy (8.6%) were relatively high. Both FTP and RCSA did not correlate with NPT-AHI. The proportion of lingual hypertrophy increased gradually with the increase of FTP and the proportions of glossoptosis in all FTP classifications were high. The patients with RCSA > 180 mm2 were mainly affected by glossoptosis and palatal tonsil hypertrophy, while patients with RCSA ≤ 180 mm2 were mainly affected by lingual hypertrophy. CONCLUSION: The percentage of patients with retrolingual obstruction in all moderate-severe OSA patients is relatively high, mainly glossoptosis, palatal tonsil hypertrophy, and lingual hypertrophy. FTP classification and RCSA can only reflect the retrolingual anatomical stenosis, but cannot fully reflect the retrolingual functional stenosis, especially the presence of glossoptosis.

Correlation Between Rapid Eye Movement Sleep Duration and Laryngopharyngeal Reflux in Patients with Obstructive Sleep Apnea.

Objectives: The aim of this study was to investigate the correlation between rapid eye movement (REM) sleep duration and laryngopharyngeal reflux (LPR) in patients with obstructive sleep apnea (OSA). Methods: In all, 99 patients with OSA were enrolled in this study, and the correlation between REM sleep duration and the severity of LPR was analyzed after the polysomnography (PSG) and reflux symptom index (RSI) scores were completed. Subsequently, a multiple linear regression analysis was performed to further clarify the factors affecting LPR. Results: Partial correlation analysis showed that the REM sleep duration was positively correlated with the RSI scores (r = 0.236, P = .022) after controlling for apnea-hypopnea index (AHI), body mass index (BMI), lowest oxygen saturation (LSO2), age, and sex. The multiple linear regression analysis indicated that only REM sleep duration was a factor influencing LPR (t = 2.330, P = .022). Conclusions: Our study found a correlation between REM sleep duration and LPR in OSA patients. The shorter the REM sleep duration, the less severe the LPR symptoms.

The effect of laryngopharyngeal reflux on arousal in patients with obstructive sleep apnea.

BACKGROUND: Laryngopharyngeal reflux (LPR) may be associated with the severity of obstructive sleep apnea (OSA). However, it is unknown whether LPR may be associated with arousal. OBJECTIVE: To clarify the effect of LPR on arousal in OSA. METHODS: This study included 120 OSA patients. The correlations between LPR scores and arousal index (ArI) were analyzed. Finally, to further clarify the effect of LPR on ArI, we analyzed the correlations between respiratory event-related arousal index (BERAI), leg-movement-related arousal index (LMRAI), snore-related arousal index (SRAI), spontaneous arousal index (SAI), and RSI score. RESULTS: Partial correlation analysis showed that the RSI score was positively correlated with ArI (p = .000), mainly correlated with BERAI and SAI (r = 0.422, p = .000; r = 0.212, p = .020). While controlling for apnea-hypopnea index (AHI), the RSI score was still positively correlated with ArI (p = .002), mainly correlated with BERAI and SAI (r = 0.252, p = .006; r = 0.200, p = .029). CONCLUSIONS AND SIGNIFICANCE: The effect of LPR symptoms on arousal in OSA exists. The more severe the LPR was, the more frequent the arousal in OSA patients was. Thereinto, respiratory event-related arousal and spontaneous arousal were the most obvious.

Measurement of Lingual Artery Using Ultrasound Versus Computed Tomography Angiography for Midline Glossectomy in Patients With Obstructive Sleep Apnea.

OBJECTIVE: To clarify the differences in assessing the course of the lingual artery between lingual artery computed tomography angiography (CTA) and ultrasound (US). METHODS: Twenty-six OSA patients were included in this study and accomplished lingual artery CTA and US, respectively. The differences in the depths of the lingual arteries and the distances between the bilateral lingual arteries on 3 measurement levels based on lingual artery CTA and US were compared. RESULTS: The depths of the lingual arteries on 3 measurement levels by CTA were deeper than those by US (P < .01). There was no significant difference in the distances between bilateral lingual arteries on 3 measurement levels between CTA and US (P > .05). CONCLUSIONS: The parameters of lingual artery measured by lingual artery US were similar to or smaller than those measured by lingual artery CTA. Like lingual artery CTA, lingual artery US could be used as an effective method to ensure the safety of the operation.

Diagnosis of Retrolingual Obstruction during Drug-Induced Sleep Endoscopy versus Polysomnography with Nasopharyngeal Tube in Patients with Obstructive Sleep Apnea.

OBJECTIVE: To compare the retrolingual obstruction during drug-induced sleep endoscopy (DISE) with the retrolingual obstruction during polysomnography with nasopharyngeal tube (NPT-PSG). METHODS: A cross-sectional study of 77 consecutive patients with moderate and severe obstructive sleep apnea (OSA) was conducted. After 15 patients were excluded from the study for not completing DISE or NPT-PSG successfully, 62 patients were included in this study. Retrolingual sites of obstruction grade 2 determined by DISE according to the VOTE (velum, oropharynx lateral wall, tongue base, and epiglottis) classification were considered as retrolingual obstruction, while apnea-hypopnea index (AHI) ≥ 15 events/hour determined by NPT-PSG was considered as retrolingual obstruction. The extent of agreement between DISE and NPT-PSG findings was evaluated using unweighted Cohen's kappa test. RESULTS: The 62 study participants (11 moderate OSA, 51 severe OSA) had a mean (SD) age of 39.8 (9.9) years, and 58 (94%) were men. No statistically significant differences between included and excluded patients were observed in patient characteristics. The extent of agreement in retrolingual obstruction between DISE and NPT-PSG was 80.6% (Cohen k = 0.612; 95% CI, 0.415-0.807). CONCLUSION: Retrolingual obstruction requiring treatment showed good agreement between DISE and NPT-PSG, suggesting that NPT-PSG may also be a reliable method to assess the retrolingual obstruction.

Ultrasonic Measurement of Lingual Artery and Its Application for Midline Glossectomy.

OBJECTIVE: To explore the application of lingual artery ultrasound (US) for midline glossectomy in patients with obstructive sleep apnea (OSA). METHODS: Lingual artery US was performed in 57 OSA patients (OSA group) and 20 normal persons (control group). The differences in the depths of the lingual arteries and the distances between the bilateral lingual arteries were compared between two groups. The correlations between apnea-hypopnea index (AHI), AHI after the nasopharyngeal tube insertion (NPT-AHI), Friedman tongue position (FTP) and all the parameters of lingual arteries were analyzed. RESULTS: Both the depths of the lingual arteries and the distances between the bilateral lingual arteries in the OSA group were larger than those in the control group (P < .01). All the parameters of the lingual arteries in OSA patients were positively correlated with AHI, NPT-AHI and FTP (P < .05). While controlling for body mass index (BMI), all the parameters of the lingual arteries in OSA patients were still correlated with NPT-AHI positively (P ≤ .01). CONCLUSION: Pre-operative US can show the course of the lingual artery clearly for pre-operative planning. The depth and width of the lingual artery in OSA patients were different from controls. NPT-AHI has high sensitivity in predicting all the parameters of the lingual arteries. FTP is closely correlated with the depth of the lingual arteries.

The effect of obstructive sleep apnea surgery on laryngopharyngeal reflux with obstructive sleep apnea.

Background: Obstructive sleep apnea (OSA) may play a role in the occurrence of laryngopharyngeal reflux (LPR). OSA surgery also may have a significant curative effect on LPR with OSA.Objectives: To analyze the role of OSA in LPR and the effect of OSA surgery on LPR with OSA.Methods: Forty-five OSA patients with LPR symptoms were enrolled and were divided into the LPR positive group (RSI > 13) and the LPR suspicious group (1 ≤ RSI ≤ 13) based on reflux symptom index (RSI). All the patients underwent OSA surgery. The RSI scores at three different time points postoperatively were compared with that preoperatively.Results: In the LPR positive and LPR suspicious group, the result revealed that there were significant differences in RSI score between one month, three months, six months after surgery and before surgery (p < .001 for all). Moreover, in the LPR positive group, there was a significant difference in RSI score among one month, three months and six months after surgery (p = .01).Conclusions and significance: The effect of OSA on LPR exists and OSA surgery can improve the symptoms of LPR with OSA obviously. For some LPR patients with OSA, the combination therapy of OSA and LPR is needed.

Application of 3D reconstruction for midline glossectomy in OSA patients.

OBJECTIVE: To explore the application of three-dimensional (3D) reconstruction technology for midline glossectomy in patients with obstructive sleep apnea (OSA). METHODS: Fifteen patients with OSA were included in this study. Each of them received computed tomography angiography (CTA) examination of lingual arteries in the resting tongue position and fully extended tongue position respectively. The two-dimensional CTA images were converted to 3D models using 3D reconstruction technology. We simulated the midline glossectomy in different tongue positions with a safe margin of 3 mm. The differences in the distances between bilateral lingual arteries, the depths of the lingual arteries and the surgical resectable volumes of the tongue were compared between different tongue positions in 3D models. RESULTS: The depths of the lingual arteries, the distances between bilateral lingual arteries based on three measuring sections and the surgical resectable volumes of the tongue in the fully extended tongue position were significantly smaller than those in the resting tongue position (P < 0.01 or 0.05). CONCLUSION: The 3D reconstruction technology can show the course of lingual artery stereoscopically and visually, and can be more beneficial to guide surgery than two-dimensional examination. Lingual artery examination in the fully extended tongue position has higher specificity in displaying intraoperative actual situation.

Modified Friedman stage in predicting glossopharyngeal obstruction in obstructive sleep apnea.

CONCLUSIONS: Modified Friedman stage can be used to predict glossopharyngeal obstruction better than before in patients with obstructive sleep apnea (OSA). OBJECTIVE: To evaluate the diagnostic value of modified Friedman stage in predicting glossopharyngeal obstruction in patients with OSA. METHODS: Eighty-five OSA patients with Friedman stage III were divided into IIIa group and IIIb group based on an imaginary line drawn in the horizontal and middle position of the soft palate. Polysomnography (PSG) was performed after nasopharyngeal tube (NPT) insertion (NPT-PSG) to diagnose glossopharyngeal obstruction. Apnea-hypopnea index (AHI) determined by NPT-PSG (NPT-AHI) and glossopharyngeal obstruction result determined by NPT-PSG (NPT-PSG result) were compared between the two groups. RESULTS: There were significant differences in NPT-AHI (p < 0.01) and NPT-PSG result (p < 0.01) between the two groups.

Lingual-occlusal surface position predicts retroglossal obstruction in patients with obstructive sleep apnea hypopnea syndrome.

CONCLUSION: Lingual-occlusal surface position was significantly related to retroglossal obstruction, and lingual-occlusal surface position may be an available reference in clinical practice for the preliminary assessment of retroglossal obstruction. OBJECTIVE: To investigate the relationship between lingual-occlusal surface position and retroglossal obstruction in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). MATERIALS AND METHODS: A total of 140 patients with OSAHS diagnosed by polysomnography (PSG) were enrolled. Lingual-occlusal surface position was evaluated and classified into three types. Airway computed tomograpy (CT) was performed to measure the retroglossal cross-sectional area and inner diameter. The PSG was repeated after the nasopharyngeal tube insertion (NPT-PSG). The NPT-PSG results, CT-measured data and incidence of retroglossal obstruction were compared among the different lingual-occlusal surface positions groups. RESULTS: The demographics of OSAHS patients with different lingual-occlusal surface positions was similar. As lingual-occlusal surface position type varied from type I to type III, retroglossal cross-sectional area and inner diameter decreased, retroglossal airway obstruction rate increased, apnea hypopnea index (AHI) measured by NPT-PSG increased, and lowest oxygen saturation (LaSO2) decreased.

Analysis of the difference in the course of the lingual arteries caused by tongue position change.

OBJECTIVES/HYPOTHESIS: To explore the difference in the course of the lingual arteries between the tongue in the fully extended position and in the resting position in obstructive sleep apnea hypopnea syndrome (OSAHS) patients. STUDY DESIGN: Prospective nonrandomized study. METHODS: Seventeen patients with OSAHS were included in the study. Each patient received two lingual artery computed tomography angiography (CTA) examinations. For the first CTA examination, each subject was requested to keep the mouth closed with the tongue in a resting position. For the second CTA examination, each subject was asked to keep the mouth open with the tongue in a fully extended position. The difference in the distances between the bilateral lingual arteries and the depths of the lingual artery beneath the lingual surface, based on three reference marks, was analyzed with the tongue in a resting and extended position using the CTA images. RESULTS: Both the depths of the lingual artery beneath the lingual surface and the distances between the bilateral lingual arteries based on three reference marks in the fully extended position were all significantly smaller than those in the resting position (P < .01 or .05). CONCLUSION: Performing lingual artery CTA on OSAHS patients with the tongue in the fully extended position preoperatively has higher sensitivity and specificity in predicting the course of the lingual artery during surgery because the mouth is open and the tongue is fully extended forward during midline glossectomy.

Reoperation on patients with obstructive sleep apnea-hypopnea syndrome after failed uvulopalatopharyngoplasty.

The goals of this study were to explore the reasons after failed uvulopalatopharyngoplasty (UPPP) in some patients with obstructive sleep apnea-hypopnea syndrome (OSAHS), and to observe the efficacy of the second surgery. Twenty-three OSAHS patients with failed UPPP were included in the study. Routine physical exams, electronic endoscopy, computed tomography scan and polysomnography after nasopharyngeal tube insertion were performed to assess the site of upper airway obstruction, and corresponding appropriate surgical treatment was carried out based on the diagnosis. Comprehensive evaluation of the 23 patients revealed that the sites of obstruction after failed UPPP were as follows: 7 cases predominantly in the oropharyngeal area, 2 cases in the nasal, nasopharyngeal and oropharyngeal area, 5 cases predominantly in the glossopharyngeal area and 9 cases in the oropharyngeal and glossopharyngeal areas. Correspondingly, 7 cases underwent improved UPPP alone, 2 cases underwent adenoidectomy or nasal expansion and improved UPPP, 5 cases underwent glossopharyngeal surgery alone and 9 cases underwent improved UPPP and glossopharyngeal surgery. Follow-up for more than 12 months showed that there were four cured cases, 12 cases with marked improvement, and 7 cases with treatment failure. The success rate was 69.6%. After undergoing UPPP, OSAHS patients may still have oropharyngeal airway obstruction. By performing a detailed preoperative assessment on the patient's airway condition and clarifying the site of obstruction, performing the second surgical treatment can still achieve a relatively satisfactory treatment outcome.

Nasopharyngeal tube: a simple and effective tool to screen patients indicated for glossopharyngeal surgery.

STUDY OBJECTIVES: The aim of this prospective controlled study was to explore the diagnostic value of repeated polysomnography (PSG) post-nasopharyngeal tube insertion in the setting of glossopharyngeal obstruction in obstructive sleep apnea hypopnea syndrome (OSAHS). METHODS: Patients were eligible for this study if they were diagnosed as OSAHS by the first PSG and presented with moderate to severe OSAHS by repeated PSG scanning post-nasopharyngeal tube insertion (NPT-PSG). Fifty-nine patients were enrolled into this study and assigned to received either modified uvulopalatopharyngoplasty (H-UPPP; n = 25) or H-UPPP in combination with glossopharyngeal surgery (n = 34). RESULTS: General data and PSG data were collected prior to and following nasopharyngeal tube insertion and were found not to be significantly different. However, both the PSG and Epworth sleepiness scale (ESS) were significantly superior in the combination group compared to the UPPP alone group post-surgery. The success rates of surgery were 82.3% and 40.0%, respectively. CONCLUSION: Patients with moderate to severe OSAHS post-nasopharyngeal tube insertion generally have glossopharyngeal obstruction. Glossopharyngeal surgery can significantly improve surgical outcome in the setting of OSAHS.

Lingua-epiglottis position predicts glossopharyngeal obstruction in patients with obstructive sleep apnea hypopnea syndrome.

The objective of the study was to investigate the relationship between lingua-epiglottis position and glossopharyngeal obstruction in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). One hundred and four patients with OSAHS diagnosed by polysomnography (PSG) were enrolled. Lingua-epiglottis position was visualized using endoscopy and classified into three types. Spiral CT imaging of the upper respiratory tract was performed to measure the cross-sectional area and inner diameter of the glossopharyngeal airway. The PSG was repeated after nasopharyngeal tube insertion (NPT-PSG). The NPT-PSG results, CT-measured data and incidence of stenosis were compared among the different lingua-epiglottis position groups. Obstructive sleep apnea hypopnea syndrome patients with different lingua-epiglottis positions had similar demographics. As lingua-epiglottis position type varied from type I to type III, cross-sectional area and inner diameter of the glossopharyngeal area decreased, glossopharyngeal airway stenosis rate increased, and apnea hypopnea index measured by NPT-PSG increased. The lowest oxygen saturation decreased. Lingua-epiglottis position was significantly related to glossopharyngeal obstruction. Lingua-epiglottis position should be used in clinical practice for the preliminary assessment of glossopharyngeal obstruction.

Localization of glossopharyngeal obstruction using nasopharyngeal tube versus Friedman tongue position classification in obstructive sleep apnea hypopnea syndrome.

Assessing the severity of glossopharyngeal obstruction is important for the diagnosis and therapy of obstructive sleep apnea hypopnea syndrome (OSAHS). The polysomnography (PSG) with nasopharyngeal tube insertion (NPT-PSG) has shown good results in assessing glossopharyngeal obstruction. The objective of this study was to compare NPT-PSG with Friedman tongue position (FTP) classification which was also used to evaluate the glossopharyngeal obstruction. One hundred and five patients with OSAHS diagnosed by PSG were included in the study. All the patients were successfully examined by NPT-PSG. Based on the grade of FTP classification, 105 patients were divided into four groups. The differences of the general clinical data, PSG and NPT-PSG results were analyzed among the four groups. And the coincidence of diagnosing glossopharyngeal obstruction of two methods was calculated. There was no significant difference among the four groups in general clinical data and PSG results. However, NPT-PSG results were significantly different among the four groups. Following with the increasing FTP, apnea hypopnea index increased and lowest saturation of blood oxygen decreased. There were 38 patients with and other 38 patients without glossopharyngeal obstruction diagnosed by both methods. The coincidence of two methods was 72.4 %. NPT-PSG is an easy and effective method in assessing the severity of glossopharyngeal obstruction. The coincidence between the NPT-PSG and FTP classification is good. But in some special OSAHS patients such as glossoptosis, unsuccessful uvulopalatopharyngoplasty or suspicious pachyglossia, NPT-PSG is better than FTP classification.

The nasopharyngeal tube: a simple and effective tool to indicate the need for uvulopalatopharyngoplasty.

OBJECTIVES/HYPOTHESIS: To compare polysomnography (PSG) data after nasopharyngeal tube (NPT) insertion and uvulopalatopharyngoplasty (UPPP), and explore the possibility of predicting UPPP outcomes with NPT-PSG. STUDY DESIGN: Prospective nonrandomized study. METHODS: PSG was performed after NPT insertion in 73 inpatients with obstructive sleep apnea-hypopnea syndrome (OSAHS). All patients accepted UPPP surgery. PSG was repeated after 12 months of UPPP to assess curative effects. Data were then compared to correlate NPT-PSG with the efficacy of UPPP. RESULTS: NPT insertion decreased the overall apnea-hypopnea index (AHI) and increased the lowest oxygen saturation (LaSO2 ). NPT-PSG results correlated well with surgical outcomes 12 months post-UPPP. The correlation coefficient for AHI and LaSO2 were 0.571 (P < .001) and 0.268 (P = .033), respectively. Next, enrolled patients were divided into two groups based on NPT-PSG results: group A, AHI <15 times/hr, 50 cases; group B, AHI ≥15 times/hr, 23 cases. The UPPP surgery success rates of the two groups were 86.0% and 39.1%, respectively. CONCLUSIONS: NPT-PSG data are closely correlated with UPPP efficacy and may assist in the selection of appropriate OSAHS patients for UPPP. An AHI ≥15 times/hr after NPT insertion indicates glossopharyngeal obstruction and suggests the need for appropriate intervention. LEVEL OF EVIDENCE: 4.

[Resection of macrosis benign parapharyngeal neoplasms via oral approach].

OBJECTIVE: To explore investigate the feasibility of transoral removal of macrosis benign neoplasms in parapharyngeal space. METHODS: Sixteen patients with well-defined macrosis benign parapharyngeal space tumors treated by surgery from January 2005 to December 2012 were enrolled in this study. All patients were assessed by CT scan, MRI and CT angiography before surgery. Surgery for the tumors with complete peplos, locating at medial side of carotid and accessible from the oropharynx was completed with the assistance of endoscope, bipolar electrocoagulation or radiofrequency ablation system. RESULTS: All neoplasms were removed by transoral approach. Tracheotomy was performed in 4 cases. All patients were treated successfully with good postoperative recovery and no significant complications. Postoperative pathological examination showed there were 9 cases of pleomorphic adenoma, 5 cases of neurilemmoma and 2 cases of neurofibroma. By the follows-up of 1-8 years (median 31 months), among 16 cases only one case of neurofibroma recurred. CONCLUSION: The transoral removal of macrosis benign neoplasms in parapharyngeal space is safe, manimally invasive and feasible in selected cases, with a high local control rate and a low surgical complication rate.

Outcomes of upper airway reconstructive surgery for obstructive sleep apnea syndrome based on polysomnography after nasopharyngeal tube insertion.

BACKGROUND: The most common obstruction sites for obstructive sleep apnea hypopnea syndrome (OSAHS) are the oropharynx and the glossopharyx. The diagnosis of glossopharyngeal airway obstruction is difficult. The study aimed to assess the effect of upper airway reconstructive surgery for OSAHS based on polysomnography (PSG) after nasopharyngeal tube insertion (NPT-PSG), and to evaluate the clinical value of NPT-PSG in localizing the obstructive sites. METHODS: Seventy-nine OSAHS patients diagnosed with PSG were included in the study. PSG was repeated with a nasopharyngeal tube in place (NPT-PSG). RESULTS: of the two PSGs were compared. A NPT-PSG apnea hypopnea index (AHI) greater than 15 times per hour was used as a threshold for glossopharyngeal surgery. The cause of glossopharyngeal airway obstruction was taken into consideration in planning glossopharyngeal surgery. Assessment of efficacy was followed-up. RESULTS: After NPT-PSG, patients' AHI significantly decreased and lowest oxygen saturation (LaSO2) significantly increased. Of the 79 patients, 47 were treated with uvulopalatopharyngoplasty (UPPP) alone and 32 with UPPP + glossopharyngeal surgery. Thirty-two patients were considered cured, 33 markedly improved, and 14 failed. The overall surgery success rate was 82.3%. CONCLUSIONS: NPT-PSG can be used as a diagnosis tool for localizing airway obstruction in OSAHS patients. Surgical treatment based on NPT-PSG results in good treatment efficacy.

Treatment of obstructive sleep apnea hypopnea syndrome caused by glossoptosis with tongue-base suspension.

The objective of the study was to evaluate a surgical method to treat patients with obstructive sleep apnea hypopnea syndrome (OSAHS) caused by suspected glossoptosis. Seventy-eight patients with OSAHS caused by suspected glossoptosis were non-randomly divided into two groups. The 45 patients in the first group received uvulopalatopharyngoplasty (UPPP) and tongue-base suspension (Repose). The 33 patients in the second group received UPPP alone. Follow-up was conducted over 6 months, and polysomnography was used to determine the effects of treatment. Follow-up results revealed that the apnea-hypopnea index (AHI) and ESS scores of the patients from both groups were substantially decreased compared to the corresponding values before surgery. The lowest oxygen saturation (LaSo2) of both groups was improved, compared to the level before surgery. The degree of improvement in patients treated with UPPP + Repose was significantly greater than that seen in patients treated with UPPP alone. In the UPPP + Repose group, 17 patients were cured, 23 showed marked improvement, and 5 did not improve. In the UPPP alone group, 1 patient was cured, 16 showed marked improvement, and 16 did not improve. The marked improvement rates of the two groups were 88.9 and 51.5 %, respectively, a significant difference. Patients who show glossopharyngeal obstruction during sleep, and have normal glossopharyngeal airway morphology when awake, should be suspected to have glossoptosis. Repose surgery is an effective operation for the patients with OSAHS suspected glossoptosis.

Predictive value of lingua/pharynx ratio for retroglossal obstruction in patients with obstructive sleep apnea hypopnea syndrome.

CONCLUSIONS: The lingua/pharynx (L/P) ratio has high sensitivity and specificity in predicting the severity of retroglossal obstruction in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). OBJECTIVE: To evaluate the diagnostic value of the L/P ratio in predicting the severity of retroglossal obstruction in patients with OSAHS. METHODS: Airway computed tomography (CT) was performed in 115 patients with OSAHS. The retroglossal cross-sectional area (RCSA) was measured at the axial level of the hypopharynx, immediately superior to the tip of the epiglottis. Moreover, nine lines, which were lined up in the order of n = 1, 2, 3, …, 9, were drawn from the genial tubercle (point G) to nine points (point P n ) proximally on the posterior pharyngeal wall and hard palate in the sagittal plane. Meanwhile, the nine lines intersected the lingual surface at point Ln, respectively. The L/P ratios of the lingual segment (G to L n distance) to the pharyngeal segment (G to P n distance) were measured. We analyzed the correlations between nine L/P values (L/P n ) and RCSA. RESULTS: Both simple linear correlation analysis and multiple linear regression analysis showed that L/P6 and L/P9 had significant negative correlations with RCSA.