Indian Journal of Sleep Medicine

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VOLUME 8 , ISSUE 1 ( January-March, 2013 ) > List of Articles

ORIGINAL ARTICLE

A clinical study of surgical outcomes in patients with obstructive sleep apnoea syndrome

Mohan Kameswaran, S Raghunandhan, S Raghunandhan, R.S Anand Kumar

Keywords : Obstructive sleep apnea syndrome, Respiratory Distress Index, Polysomnography, Sleep MRI, Epworth sleepiness scale.

Citation Information : Kameswaran M, Raghunandhan S, Raghunandhan S, Kumar RA. A clinical study of surgical outcomes in patients with obstructive sleep apnoea syndrome. Indian Sleep Med 2013; 8 (1):25-32.

DOI: 10.5958/j.0974-0155.8.1.006

License: NA

Published Online: 01-06-2018

Copyright Statement:  NA


Abstract

Introduction: Snoring & Obstructive Sleep Apnea Syndrome (OSAS) is a globally prevalent problem which is increasingly being recognized in recent times. The treatment modalities include medical appliances & surgery. It is mandatory to have a rational approach in the management of obstructive sleep apnoes. Patients are given Continuous Positive Airway Pressure(CPAP) support or advised surgical correction as per the level of obstruction diagnosed by Sleep MRI and the severity as per the Polysomnography. A judicious selection of cases needs to be done for surgical management. Patients unfit for surgery and those who prefer medical treatment are advised CPAP as the primary modality of treatment. A small group of patients need surgical intervention followed by CPAP support. Objectives: To assess the outcomes of various surgical procedures in the management of OSAS and to define a comprehensive protocol for objective assessment of OSAS with Dynamic MRI andPolysomnography. Materials & Methods: A cohort of 100 patientsin the age group 27 – 64 years were diagnosed with OSAS and were treated at our institute over a period of one year (January 2010 – January 2011). All patients were evaluated with Epworth sleepiness scale (ESS) and investigated with Dynamic MRI and Polysomnography. As per the management protocols defined in the study, surgeries were performed in 38 patients with severe compromise of the airway, while the other group of 62 patients,and were provided CPAP. The 38 patients selected for surgery were included into this prospective study. Successful outcomes among these 38 patients were analyzed at the end of the study period. Four patients with mixed apnoearequired multimodal therapy which included surgery followed by CPAP support. Results: Among the 38,patients, surgery proved successful in 34 patients in whom AHI reduced from 38.27 to 14.54 (62%) and ESS improved by almost 10 points. FourPatients among the surgical group had persistence of symptoms due to persistence of mixedapnoea & they were given CPAP support. Inferences derived from the above results proved the success of various surgical interventions in the management of OSAS. Conclusion:A critical analysis of the anatomical & physiological factors inducing obstructive episodes & an appropriate treatment plan is vital, to produce successful outcomesin patients with OSAS. Failure of surgical procedures, are often due to improper case selection. A small group of patients may require multimodal therapy with surgery and CPAP.


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  1. Charles B. Croft, Michael B. Pringle. Snoring and sleep apnea. Scott-Brown's otolaryngology. 1997: 4/19/1.
  2. Suto Y, Matsuda E, Inoue Y, Suzuki T, Ohta Y. Sleep Apnea Syndrome. Comparison of MR imaging of the oropharynx with physiologic Indexes. Radiology 1996;201:393-8.
  3. Sher JW, Schechtman KB, Piccirillo JF. The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep 1996; 19:156- 77.
  4. Kamani Y. Outpatient Treatment Of Sleep Apnea Syndrome With Co2 Laser:Laser Assisted Uppp. J Otolaryngol 24:395- 398,1994.
  5. Walker RP,Garrity T, Gopalasami C. Early polysomnographic findings and long term subjective results in sleep apnea patients treated with LAUP. Laryngoscope 1999; 109:1438-1444.
  6. Johnson, NT, Chin J. Uvulopalatopharyngoplasty and inferior sagittal Mandibular osteotomy with Genioglossus advancement for treatment of obstructive sleep apnea. Chest 105; 278:1994.
  7. Thatcher GW, Maisel RH. The long term evaluation of tracheostom in the management of obstructive sleep apnoea. Laryngoscope. 2003; 113:201-4.
  8. Campanini A, De Vito A, Frassineti S, Vieini C. Temporary tracheostomy in the surgical treatment of obstructive sleep apoea syndrome: personal experience. Actaotorhinolaryngological italic.2003; 23:474-8.
  9. Lee Nr,Givens CD Jr, Wilson J, et al. Staged surgical treatment of obstructive sleep apnea syndromy: A review of 35 patients. J oral maxillofacsurg 1999; 57:382-5.
  10. Bettega G, Pepin J, Veale D, et al. Obstructive sleep apnea syndrome: Fifty one consecutive patients treated by maxillofacial surgery. Am J Respire Crit Care Med 2000; 162:641-9.
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