The application of CT to localize the upper airway obstruction plane in patients with OSAHS.

OBJECTIVE: To identify a correlation in terms of airway obstruction between awake and sleep apnea using spiral computed tomography (CT). STUDY DESIGN: Case series with planned data collection. SETTING: College medical center. METHODS: Sixty-one patients diagnosed with obstructive sleep apnea/hypopnea syndrome (OSAHS) underwent CT scans under 3 conditions: quiet breathing while awake, the end of deep inspiration during wakefulness, and apnea while asleep. The upper airway morphology under the 3 conditions was compared, and the accuracy of the obstructive planes as determined by CT scans under the 2 awake conditions was analyzed while considering the obstructive planes that occurred during apnea as a reference. RESULTS: The differences in the anteroposterior diameter, lateral dimension, and cross-sectional area of the retropalatal and retroglossal regions among the 3 states were statistically significant. Obstruction of the retropalatal region occurred in 100%, whereas retroglossal obstruction occurred in 44.3% of the 61 cases during sleep apnea. The coincidence rate between the awake quiet breathing and the sleep apnea was 85.2% in the retropalatal obstruction and 52.5% in the retroglossal obstruction. The coincidence rate between the awake deep inspiration and the sleep apnea was 82.0% in the retropalatal obstruction and 54.1% in the retroglossal obstruction. CONCLUSION: The main obstructive plane in patients with OSAHS was the retropalatal region. An awake upper airway CT scan can properly diagnose palatopharyngeal obstruction; however, it is not suitable for detecting retroglossal obstruction.

Predictors of surgical outcomes of uvulopalatopharyngoplasty for obstructive sleep apnea hypopnea syndrome.

OBJECTIVES: To investigate predictors of surgical outcomes of uvulopalatopharyngoplasty (UPPP) for obstructive sleep apnea hypopnea syndrome (OSAHS). STUDY DESIGN: Case series with planned data collection. SETTING: A university medical center. SUBJECTS AND METHODS: Thirty-nine patients with OSAHS received Z-palatopharyngoplasty (ZPPP) or Han-uvulopalatopharyngoplasty (H-UPPP). All patients were evaluated within 3 months before surgery and at 6 to 12 months after surgery. Statistical analyses were conducted on preoperative parameters that could have affected surgical efficacy and outcome. Success was defined as an apnea-hypopnea index (AHI) fewer than 20 times per hour and a decrease of more than 50%. RESULTS: The success rate was 56.4% (22/39 patients). There were statistically significant differences in AHI, lowest oxygen saturation (L-Sao(2)), time with oxygen saturation less than 90% (CT90), percentage of time with oxygen saturation less than 90% (CT90%), microarousal index (MI), apolipoprotein E (ApoE), high-density lipoprotein (HDL), fasting blood glucose (FBG), and Friedman OSA stage between the treatment success and failure groups. Higher success rate was predicted by lower severity, as indicated by lower AHI, CT90, CT90%, and MI; higher L-Sao(2); and fewer glucose and lipid metabolism abnormalities, shown by lower ApoE and FBG and higher HDL. CONCLUSIONS: Disease severity, glucose and lipid metabolism, and Friedman OSA stage may be important predictors of surgical outcome of UPPP for OSAHS.

[Maxillomandibular advancement for obstructive sleep apnea/hypopnea syndrome].

OBJECTIVE: To explore effectiveness of maxillomandibular advancement (MMA) in the treatment of obstructive sleep apnea/hypopnea syndrome (OSAHS). METHODS: MMA was performed in 10 OSAHS patients with mandibular dysplasia diagnosed by mandibular protrusion angle (SNB) < 75 degrees and a posterior airway space (PAS) < 11 mm. Six patients had uvulopalatopharyngoplasty (UPPP) also. Six patients had over 6 months postoperative follow up. RESULTS: The blood loss was about 250-600 ml in the operation, and the serious complications didn't happen. The patients were satisfied with the postoperative facial change. Based on success criteria of 2009, of 5 patients showed highly responsive result and 1 patient was responsive (valid). rate was 83% and the responsive rate 100%. The snoring loudness score and Epworth sleepy score were reduced from preoperative 8 (6-10) and 15 (11-24) to postoperative 2 (0-4) and 5 (1-8). AHI was reduced from preoperative 52.2 (23.7-83.8) to postoperative 12.6 (7.6-31.8), lowest mean oxygen saturation increased from 0.64 (0.57-0.83) to 0.82 (0.78-0.93). Percentage of time with oxyhemoglobin saturation below 0.90 (CT90) reduced from 21.0% (12.0%-37.2%) to 2.0% (0%-8.0%). CONCLUSIONS: MMA is effective for the OSAHS patients with mandibular dysplasia.