ABSTRACT
BACKGROUND: Standard management has been recommended for obstructive sleep apnea (OSA) by several guidelines, but patient choice in the practical setting is unclear. METHODS: A survey nested in two prospective cohort studies of OSA (enrollment: 2001-2010) in China. The last interview was conducted between July 2014 and May 2015, using a comprehensive 10-point questionnaire administered in a face-to-face or telephone interview, and assessed (I) whether the participant had received any OSA treatment; (II) why he or she had decided for or against treatment; (III) what treatment was received; (IV) whether the participant used continuous positive airway pressure (CPAP) or OA daily; and (V) the perceived efficacy of therapy. RESULTS: A total of 4,097 subjects with a mean age of 45 years [37-55] responded to this survey, with a response rate of 79.4% (4,097/5,160); 2,779 subjects (67.8%) did not receive any treatment: 1,485 (53.4%) believed that their condition was not serious, despite severe OSA in 53.7% of the patients. A multivariate regression showed that the decision to receive treatment was associated with: age between 45-59 years [odds ratio (OR) 0.805, 95% CI: 0.691-0.936; P<0.001], female gender (OR 0.492, 95% CI: 0.383-0.631; P<0.001), severe OSA (OR 1.92, 95% CI: 1.01-3.64; P<0.001), hypertension (OR 1.414, 95% CI: 1.209-1.654; P<0.001) and diabetes (OR 1.760, 95% CI: 1.043-2.972; P=0.034). In subjects receiving treatment (n=1,318), 50.9% reported negative perceptions about the treatments. CONCLUSIONS: Nearly two thirds of Chinese patients choose not to receive treatment after OSA diagnosis, and nearly half are negative about their treatments for OSA. This requires clinical attention, and warrants further study in different geographic settings.
ABSTRACT
BACKGROUND: This study aimed to evaluate the efficacy and safety of primary maxillomandibular advancement (MMA) with concomitant adjunctive revised uvulopalatopharyngoplasty with uvula preservation (H-UPPP) in selected patients with severe obstructive sleep apnea-hypopnea syndrome (OSASH). METHODS: Eleven consecutive male patients with velo-orohypopharyngeal and hypopharyngeal narrowing underwent MMA with concomitant H-UPPP for severe OSAHS. All patients underwent a physical examination, Epworth Sleepiness Scale evaluation, cephalometry, nocturnal polysomnogram, and velopharyngeal insufficiency questionnaire survey before and at 6 to 12 months after surgery. RESULTS: On the basis of the success criteria, defined as an apnea-hypopnea index less than 20 and a decrease greater than 50%, the success rate was 91%. The apnea-hypopnea index decreased from 67.44 (13.30) to 9.41 (7.20) events per hour (P < 0.001) and the lowest oxygen saturation increased from 63.0% (10.70%) to 88.55% (4.59%) (P < 0.001) after surgery. All patients showed a significant decrease in mandibular plane to hyoid bone and increase in PAS after surgery. One patient reported regurgitation of liquids when drinking hastily after surgery. Two patients reported regurgitation as occasional occurrences. Half a year later, 2 patients reported complete resolution of the symptoms. One patient still complained of rare regurgitation of liquids when drinking quickly. Five patients had paresthesia of the lower lip; in 4 patients, the paresthesia had resolved by 12 months after surgery. One patient still complained of paresthesia of the lower lip after 2 years of follow-up. No major complication (eg, upper airway obstruction) occurred. CONCLUSIONS: Primary MMA with concomitant adjunctive H-UPPP is effective in selected patients with severe OSAHS without major complications.
