Lateral oropharyngeal wall and supraglottic airway collapse associated with failure in sleep apnea surgery.
Lateral oropharyngeal wall and supraglottic airway collapse associated with failure in sleep apnea surgery.
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DOI：
10.1002/lary.22474
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发表时间：
2012-02
期刊：
影响因子：
2.6
通讯作者：
Lin, Ho-Sheng
中科院分区：
文献类型：
--
作者：
Soares, Danny;Sinawe, Hadeer;Folbe, Adam J.;Yoo, George;Badr, Safwan;Rowley, James A.;Lin, Ho-Sheng
关键词：
旨在确定术前药物诱导睡眠内窥镜检查 (DISE) 期间气道塌陷的模式，作为阻塞性睡眠呼吸暂停低通气综合征 (OSAHS) 患者多级气道手术后手术失败的预测因素。回顾性临床图表审查。对接受针对 OSHAS 治疗的上呼吸道特定部位手术改造的患者的医疗记录进行了审查。如果患者接受了 DISE 术前气道评估以及术前和术后多导睡眠监测，则患者被纳入本研究。 DISE 上的气道阻塞根据气道水平、严重程度和塌陷轴进行描述。严重气道阻塞定义为内窥镜检查中> 75％的塌陷。手术成功被描述为术后呼吸暂停低通气指数 (AHI) <20 且术前 AHI 下降 >50%。本研究共纳入 34 名患者。总体手术成功率为56%。手术成功 (n = 19) 和手术失败 (n = 15) 患者在年龄、性别、体重指数、术前 AHI、Friedman 分期、腺样体扁桃体分级和手术治疗方面相似。与手术成功组相比，手术失败组的 DISE 结果表明，严重口咽侧壁塌陷（73.3% vs. 36.8%，P = .037）和严重声门上塌陷（93.3% vs. 63.2%，P = .046）的发生率更高。术前 DISE 时出现严重的咽侧壁和/或声门上塌陷与 OSAHS 手术失败相关。识别这种容易失败的塌陷模式可能有助于术前患者咨询以及指导 OSHAS 治疗的个体化和定制方法。
To identify patterns of airway collapse during preoperative drug-induced sleep endoscopy (DISE) as predictors of surgical failure following multilevel airway surgery for patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Retrospective clinical chart review. Medical records of patients who underwent site-specific surgical modification of the upper airway for treatment of OSHAS were reviewed. Patients were included in this study if they had a preoperative airway evaluation with DISE as well as preoperative and postoperative polysomnography. Airway obstruction on DISE was described according to airway level, severity, and axis of collapse. Severe airway obstruction was defined as >75% collapse on endoscopy. Surgical success was described as a postoperative apnea-hypopnea index (AHI) of <20 and a >50% decrease in preoperative AHI. A total of 34 patients were included in this study. The overall surgical success rate was 56%. Surgical success (n = 19) and surgical failure (n = 15) patients were similar with regard to age, gender, body mass index, preoperative AHI, Friedman stage, adenotonsillar grades, and surgical management. DISE findings in the surgical failure group demonstrated greater incidence of severe lateral oropharyngeal wall collapse (73.3% vs. 36.8%, P = .037) and severe supraglottic collapse (93.3% vs. 63.2%, P = .046) as compared to the surgical success group. The presence of severe lateral pharyngeal wall and/or supraglottic collapse on preoperative DISE is associated with OSAHS surgical failure. The identification of this failure-prone collapse pattern may be useful in preoperative patient counseling as well as in directing an individualized and customized approach to the treatment of OSHAS.
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