Long-term surgical follow-up of sleep apnea syndrome.

During a 10-year period, 845 patients suspected of having sleep apnea syndrome underwent overnight monitoring at our institution. We report herein the results of a study of 204 surgical patients who responded to a questionnaire survey. Of these 204 cases, 86 (42%) showed a > or = 75% postoperative improvement in the apnea-hypopnea index (AHI) (or AHI < 10) and 48 (24%) showed an improvement of > or = 50%. Based on the data obtained from the questionnaire survey we studied the long-term postoperative improvement as well as the long-term prognosis in terms of the postoperative improvements in AHI and body weight.

Posture of patients with sleep apnea during sleep.

The relationship between sleep apnea syndrome (SAS) and posture during sleep has been noted and the beneficial effect of an optimal posture on sleep apnea has been empirically indicated. We investigated this effect in a group of subjects that included obese patients and found that the apnea-hypopnea index (AHI) may be normalized in the lateral position, even among patients severely affected with apnea. Among those with intermediate or lower AHI values sleeping in a lateral position markedly improved the symptoms, with AHI even approaching the normal range in many patients. A tendency was noted for AHI to rise regardless of posture but in proportion to the increase in body mass index (BMI). In other words, the improvement due to changes in posture became increasingly insignificant with increase in BMI.

Endoscopic examination of obstructive sleep apnea syndrome patients during drug-induced sleep.

Sixty patients diagnosed with obstructive sleep apnea syndrome (OSAS) underwent uvulopalatopharyngoplasty (UPPP). The effects of surgery were studied based on endoscopic findings during drug-induced sleep and determination of the apnea-hypopnea index (AHI) before and after the operation. Changes in the form of the airway during sleep in the recumbent position were observed, and the role of upper airway endoscopy in the diagnosis and surgical treatment of OSAS was determined. The site of airway obstruction during sleep induced by i.v. injection of 10 mg of diazepam was classified into five types, and changes in AHI and the site of airway obstruction were compared before and after surgery. Changes in airway morphology during sleep in the supine and recumbent positions were also compared before surgery. The postoperative improvement rate was 74.4% for the soft palatal type of obstruction, 76.2% for the tonsillar type, 53.3% for the circumferential palatal type and 34.0% for the mixed type. Treatment produced excellent or good effects for the soft palatal and tonsillar types of obstruction. However, many patients with the circumferential palatal and mixed types of obstruction showed only some improvement or no change. Good airway morphology was maintained in the recumbent position by patients with the soft palatal type of obstruction. With the circumferential palatal and mixed types of obstruction, improvement can be expected from operations which include surgical treatment of the posterior pharyngeal wall or lateral funiculus, or with midline laser glossectomy. A good operative outcome can be predicted in patients showing improvement of apnea in the recumbent position preoperatively.

Comparison of surgery and nasal continuous positive airway pressure treatment for obstructive sleep apnea syndrome.

Uvulopalatopharyngoplasty (UPPP) and nasal continuous positive airway pressure (n-CPAP) are used for the treatment of obstructive sleep apnea syndrome (OSAS). Although OSAS results from an abnormality of the pharynx, very little research has been carried out regarding the selection of UPPP or n-CPAP according to the type of abnormality. We performed n-CPAP titration before and after surgery, compared the treatment methods and evaluated the effect of the medical therapy. A sleep polygraph was recorded on the first night of admission and patients diagnosed with OSAS underwent n-CPAP titration on the second night. The blocked region was identified by means of endoscopic examination. A couple of months after surgery, polysomnography was repeated to determine the effect of surgery and the pressure level during n-CPAP forpatients who showed < 50% improvement in the apnea-hypopnea index. The results of surgery were poor in cases revealed by endoscopy to have the circumferential type of obstruction, but good for the soft palate and tonsil types. When endoscopic examinations were performed in conjunction with n-CPAP, the treatment was observed to act on the pharynx and to expand the airway in all cases Combined medical treatments were effective in cases where n-CPAP alone was ineffective due to high pressure.

Laser midline glossectomy and lingual tonsillectomy as treatments for sleep apnea syndrome.

Preservation treatments for sleep respiratory disorders, such as the use of a dental device and the technique of nasal continuous positive air pressure, cause discomfort to the patient and are not radical treatments. Therefore, we performed operative therapy instead. Laser midline glossectomy was performed to treat constriction at the root of the tongue in 16 patients diagnosed with sleep apnea syndrome. We also tried lingual tonsil excision using the Harmonic Scalpel in three patients with stenosis at the base of the tongue.

Application of lingual tonsillectomy to sleep apnea syndrome involving lingual tonsils.

In sleep apnea syndrome, surgical treatment is applied in obstructive-type cases and some mixed-type cases. If the obstructive part is in the root of the tongue, forward transfer of the tongue, lingual tonsillectomy and laser midline glossectomy are applied. In this study, we demonstrate the surgical technique of lingual tonsillectomy using an ultrasonic coagulating dissector (SonoSurg) with a blade tip shape developed in our department. We conclude that lingual tonsillectomy using SonoSurg, which we have frequently used, should be the first choice of treatment for snoring and sleep apnea caused by hypertrophy of the lingual tonsils from the viewpoints of effectiveness, prevention of hemorrhage, safety and handling.

Posture of Patients with Sleep Apnea During Sleep.

The relationship between sleep apnea syndrome (SAS) and posture during sleep has been noted and the beneficial effect of an optimal posture on sleep apnea has been empirically indicated. We investigated this effect in a group of subjects that included obese patients and found that the apnea-hypopnea index (AHI) may be normalized in the lateral position, even among patients severely affected with apnea. Among those with intermediate or lower AHI values, sleeping in a lateral position markedly improved the symptoms, with AHI even approaching the normal range in many patients. A tendency was noted for AHI to rise regardless of posture but in proportion to the increase in body mass index (BMI). In other words, the improvement due to changes in posture became increasingly insignificant with increase in BMI.