Artikel
Multi-Level Surgery in obstructive sleep apnea – First results of a new therapy algorithm
Suche in Medline nach
Autoren
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Christian Jost
- ENT Head an Neck Surgery Hamburg Harburg, Hamburg, Germany
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Thomas Verse
- ENT Head an Neck Surgery Hamburg Harburg, Hamburg, Germany
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Kerstin Rohde
- ENT Head an Neck Surgery Hamburg Harburg, Hamburg, Germany
| Veröffentlicht: | 23. Juli 2012 |
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Gliederung
Text
Contrary to our previous operative algorithm to treat obstructive sleep apnea (OSA) we nowadays modified the algorithm from using a fix combination of operation techniques to selecting the different components of a multi-level-surgery (MLS) concept according to an algorithm based on the severity of OSA, the clinical examination of the patient awake and in sleep endoscopy.
Aim of the study was to review the results of this new therapy algorithm.
Patients and Method: Patient data of 72 patients with OSA were included in the study. In 42 patients we found completed data pre- and postoperative. We examined a visual scale of the intensity of snoring, a questionnaire about daytime sleepiness (Epworth sleepiness-scale (ESS)) and the dataset of the pre- and postoperative polysomnografie.
Results: The Apnea-Hypopnea-Index (AHI) for the whole group was reduced from 25.3±16.6 to 8.5±7.6. Included were 17 patients with mild OSA (AHI under 20), 19 patients with intermediate OSA (AHI<40) and 6 patients with severe OSA (AHI>40). The subgroups were analysed separately.
Each group showed a reduction in AHI and oxygen desaturation index (ODI). In patients with intermediate and severe OSA the reduction was statistically significant (p<0.05).
Surgical Sucess rates according to Sher criteria showed a sucess rate in patients with mild OSA in 47%, in patients with intermediate OSA in 84% and patients with severe OSA even showed a sucess rate of 100%. All three subgroups presented with a statistical significant reduction of daytime sleepiness (ESS) and the intensity of the snoring. Body-mass-index (BMI) was pre- as postoperative 28 kg/m2 (SD±3).
Discussion:The spectrum of different components of MLS range from minimal invasive techniques to very invasive operative procedures. The selection of patients and their individual procedure can be achieved by the anatomical findings awake and in sleep endoscopy. Even in patients with severe OSA, the postoperative results can be excellent when selected carefully. The algorithm for mild OSA should be revised critically.
