Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2020, Vol. 34 ›› Issue (5): 145-151.doi: 10.6040/j.issn.1673-3770.0.2019.586

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Analysis of the preoperative predictive factors of Uvulopalatopharyngoplasty

  

  • Received:2019-11-25 Published:2020-11-17

Abstract: Obstructive sleep apnea(OSA)is a common sleep-related respiratory disorder. If left untreated, it can lead to cardiovascular and nervous system damage. In addition to continuous positive airway pressure(CPAP), most OSA patients have surgical treatment based on the anatomical obstruction. Uvulopalatopharyngoplasty(UPPP)is the most common procedure performed. This paper reviews the current research on the preoperative evaluation of UPPP, summarizes possible predictors, and screens out more specific predictive factors. The aim is to construct a more efficient predictive system, specify the indications and contraindications of UPPP surgery.

Key words: Obstructive sleep apnea, Uvulopalatopharyngoplasty, Efficacy, Prediction

CLC Number: 

  • R766
[1] Sher AE, Schechtman KB, Piccirillo JF. The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome[J]. Sleep, 1996, 19(2): 156-177. doi:10.1093/sleep/19.2.156.
[2] 中国医师协会睡眠医学专业委员会. 成人阻塞性睡眠呼吸暂停多学科诊疗指南[J]. 中华医学杂志, 2018, 98(24): 1902-1914. doi:10.3760/cma.j.issn.0376-2491.2018.24.003.
[3] 中华医学会呼吸病学分会睡眠呼吸疾病学组. 阻塞性睡眠呼吸暂停低通气综合征诊治指南(草案)[J]. 现代实用医学, 2003, 15(3): 192-195.
[4] Fukuda N, Abe T, Katagiri M, et al. Effects of uvulopalatopharyngoplasty on patients with obstructive sleep apnea: the severity of preoperative tonsillar hypertrophy[J]. J Jpn Respir Soc, 1998, 36(1): 34-40. doi:http://dx.doi.org/.
[5] Friedman M, Ibrahim H, Joseph NJ. Staging of obstructive sleep apnea/hypopnea syndrome: a guide to appropriate treatment[J]. Laryngoscope, 2004, 114(3): 454-459. doi:10.1097/00005537-200403000-00013.
[6] Friedman M, Vidyasagar R, Bliznikas D, et al. Does severity of obstructive sleep apnea/hypopnea syndrome predict uvulopalatopharyngoplasty outcome?[J]. Laryngoscope, 2005, 115(12): 2109-2113. doi:10.1097/01.MLG.0000181505.11902.F7.
[7] Braga A, Grechi TH, Eckeli A, et al. Predictors of uvulopalatopharyngoplasty success in the treatment of obstructive sleep apnea syndrome[J]. Sleep Med, 2013, 14(12): 1266-1271. doi:10.1016/j.sleep.2013.08.777.
[8] Millman RP, Carlisle CC, Rosenberg C, et al. Simple predictors of uvulopalatopharyngoplasty outcome in the treatment of obstructive sleep apnea[J]. Chest, 2000, 118(4): 1025-1030. doi:10.1378/chest.118.4.1025.
[9] Kim SJ, Kim YS, Park JH, et al. Cephalometric predictors of therapeutic response to multilevel surgery in patients with obstructive sleep apnea[J]. J Oral Maxillofac Surg, 2012, 70(6): 1404-1412. doi:10.1016/j.joms.2011.03.016.
[10] Li HY, Wang PC, Chen YP, et al. Critical appraisal and meta-analysis of nasal surgery for obstructive sleep apnea[J]. Am J Rhinol Allergy, 2011, 25(1): 45-49. doi:10.2500/ajra.2011.25.3558.
[11] Alt JA, DeConde AS, Mace JC, et al. Quality of life in patients with chronic rhinosinusitis and sleep dysfunction undergoing endoscopic sinus surgery: a pilot investigation of comorbid obstructive sleep apnea[J]. JAMA Otolaryngol Head Neck Surg, 2015, 141(10): 873-881. doi:10.1001/jamaoto.2015.1673.
[12] Wang MJ, Liu SY, Zhou B, et al. Effect of nasal and sinus surgery in patients with and without obstructive sleep apnea[J]. Acta Otolaryngol, 2019, 139(5): 467-472. doi:10.1080/00016489.2019.1575523.
[13] Wu J, Zhao GQ, Li YC, et al. Apnea-hypopnea index decreased significantly after nasal surgery for obstructive sleep apnea: a meta-analysis[J]. Medicine(Baltimore), 2017, 96(5): e6008. doi:10.1097/MD.0000000000006008.
[14] Shuaib SW, Undavia S, Lin J, et al. Can functional septorhinoplasty independently treat obstructive sleep apnea?[J]. Plast Reconstr Surg, 2015, 135(6): 1554-1565. doi:10.1097/PRS.0000000000001285.
[15] Park CY, Hong JH, Lee JH, et al. Clinical effect of surgical correction for nasal pathology on the treatment of obstructive sleep apnea syndrome[J]. PLoS One, 2014, 9(6): e98765. doi:10.1371/journal.pone.0098765.
[16] Friedman M, Tanyeri H, Lim JW, et al. Effect of improved nasal breathing on obstructive sleep apnea[J]. Otolaryngol Head Neck Surg, 2000, 122:71-74. doi: 10.1016/S0194-5998(00)70147-1.
[17] Young T, Finn L, Palta M. Chronic nasal congestion at night is a risk factor for snoring in a population-based cohort study[J]. Arch Intern Med, 2001, 161(12): 1514-1519. doi:10.1001/archinte.161.12.1514.
[18] McNicholas WT, Tarlo S, Cole P, et al. Obstructive apneas during sleep in patients with seasonal allergic rhinitis[J]. Am Rev Respir Dis, 1982, 126(4): 625-628. doi:10.1164/arrd.1982.126.4.625.
[19] Sabato R, Guido P, Salerno FG, et al. Airway inflammation in patients affected by obstructive sleep apnea[J]. Arch Monaldi Le Malattie Del Torace, 2006, 65(2): 102-105. doi:10.4081/monaldi.2006.572.
[20] Hastan D, Fokkens WJ, Bachert C, et al. Chronic rhinosinusitis in Europe: an underestimated disease. A GA2LEN study[J]. Allergy, 2011, 66(9): 1216-1223. doi:10.1111/j.1398-9995.2011.02646.x.
[21] Fibbi A, Ameli F, Brocchetti F, et al. Tongue base suspension and radiofrequency volume reduction: a comparison between 2 techniques for the treatment of sleep-disordered breathing[J]. Am J Otolaryngol, 2009, 30(6): 401-406. doi:10.1016/j.amjoto.2008.08.006.
[22] Farrar J, Ryan J, Oliver E, et al. Radiofrequency ablation for the treatment of obstructive sleep apnea: a meta-analysis[J]. Laryngoscope, 2008, 118(10): 1878-1883. doi:10.1097/MLG.0b013e31817d9cc1.
[23] Powell NB, Riley RW, Guilleminault C. Radiofrequency tongue base reduction in sleep-disordered breathing: a pilot study[J]. Otolaryngol Head Neck Surg, 1999, 120(5): 656-664. doi:10.1053/hn.1999.v120.a96956.
[24] Li KK, Powell NB, Riley RW, et al. Temperature-controlled radiofrequency tongue base reduction for sleep-disordered breathing: Long-term outcomes[J]. Otolaryngol Head Neck Surg, 2002, 127(3): 230-234. doi:10.1067/mhn.2002.126900.
[25] Steward DL, Weaver EM, Woodson BT. A comparison of radiofrequency treatment schemes for obstructive sleep apnea syndrome[J]. Otolaryngol Head Neck Surg, 2004, 130(5): 579-585. doi:10.1016/j.otohns.2004.01.012.
[26] Koutsourelakis I, Safiruddin F, Ravesloot M, et al. Surgery for obstructive sleep apnea: sleep endoscopy determinants of outcome[J]. Laryngoscope, 2012, 122(11): 2587-2591. doi:10.1002/lary.23462.
[27] Steinhart H, Kuhn-Lohmann J, Gewalt K, et al. Upper airway collapsibility in habitual snorers and sleep apneics: evaluation with drug-induced sleep endoscopy[J]. Acta Otolaryngol, 2000, 120(8): 990-994. doi:10.1080/00016480050218753.
[28] Gislason T, Lindholm CE, Almqvist M, et al. Uvulopalatopharyngoplasty in the sleep apnea syndrome. Predictors of results[J]. Arch Otolaryngol Head Neck Surg, 1988, 114(1): 45-51. doi:10.1001/archotol.1988.01860130049013.
[29] Larsson LH, Carlsson-Nordlander B, Svanborg E. Four-year follow-up after uvulopalatopharyngoplasty in 50 unselected patients with obstructive sleep apnea syndrome[J]. Laryngoscope, 1994, 104(11 Pt 1): 1362-1368. doi:10.1288/00005537-199411000-00008.
[30] Shie DY, Tsou YA, Tai CJ, et al. Impact of obesity on uvulopalatopharyngoplasty success in patients with severe obstructive sleep apnea: a retrospective single-center study in Taiwan[J]. Acta Otolaryngol, 2013, 133(3): 261-269. doi:10.3109/00016489.2012.741328.
[31] Janson C, Gislason T, Bengtsson H, et al. Long-term follow-up of patients with obstructive sleep apnea treated with uvulopalatopharyngoplasty[J]. Arch Otolaryngol-Head Neck Surg, 1997, 123(3): 257-262. doi:10.1001/archotol.1997.01900030025003.
[32] Choi JH, Cho SH, Kim SN, et al. Predicting outcomes after uvulopalatopharyngoplasty for adult obstructive sleep apnea: a meta-analysis[J]. Otolaryngol Head Neck Surg, 2016, 155(6): 904-913. doi:10.1177/0194599816661481.
[33] He M, Yin GP, Zhan SY, et al. Long-term efficacy of uvulopalatopharyngoplasty among adult patients with obstructive sleep apnea: a systematic review and meta-analysis[J]. Otolaryngol Head Neck Surg, 2019, 161(3): 401-411. doi:10.1177/0194599819840356.
[34] Dündar A, Gerek M, Ozünlü A, et al. Patient selection and surgical results in obstructive sleep apnea[J]. Eur Arch Otorhinolaryngol, 1997, 254(Suppl 1): S157-S161. doi:10.1007/bf02439750.
[35] Li HY, Wang PC, Lee LA, et al. Prediction of uvulopalatopharyngoplasty outcome: anatomy-based staging system versus severity-based staging system[J]. Sleep, 2006, 29(12): 1537-1541. doi:10.1093/sleep/29.12.1537.
[36] Xiong YP, Yi HL, Yin SK, et al. Predictors of surgical outcomes of uvulopalatopharyngoplasty for obstructive sleep apnea hypopnea syndrome[J]. Otolaryngol Head Neck Surg, 2011, 145(6): 1049-1054. doi:10.1177/0194599811420811.
[37] Bostanci A, Bozkurt S, Turhan M. The relationship between the duration of obstructive respiratory events and outcomes of multilevel upper airway surgery in patients with obstructive sleep apnea[J]. Eur Arch Otorhinolaryngol, 2016, 273(9): 2651-2657. doi:10.1007/s00405-015-3781-8.
[38] Kezirian EJ, Weaver EM, Yueh B, et al. Risk factors for serious complication after uvulopalatopharyngoplasty[J]. Arch Otolaryngol Head Neck Surg, 2006, 132(10): 1091-1098. doi:10.1001/archotol.132.10.1091.
[39] Suen C, Ryan CM, Mubashir T, et al. Sleep study and oximetry parameters for predicting postoperative complications in patients with Osa[J]. Chest, 2019, 155(4): 855-867. doi:10.1016/j.chest.2018.09.030.
[40] Hwang D, Shakir N, Limann B, et al. Association of sleep-disordered breathing with postoperative complications[J]. Chest, 2008, 133(5): 1128-1134. doi: 10.1378/chest.07-1488.
[41] Zhang JB, Li YR, Cao X, et al. The combination of anatomy and physiology in predicting the outcomes of velopharyngeal surgery[J]. Laryngoscope, 2014, 124(7): 1718-1723. doi:10.1002/lary.24510.
[42] 叶京英, 张俊波. 腭咽部手术治疗阻塞性睡眠呼吸暂停低通气综合征疗效的预测[J]. 中华耳鼻咽喉头颈外科杂志, 2016, 51(4): 317-320. doi:10.3760/cma.j.issn.1673-0860.2016.04.020. YE Jingying, ZHANG Junbo. Prediction of the efficacy of velopharyngeal surgery for obstructive sleep apnea hypopnea syndrome[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2016, 51(4): 317-320. doi:10.3760/cma.j.issn.1673-0860.2016.04.020.
[43] Liu SR, Yi HL, Yin SK, et al. Associated predictors of therapeutic response to uvulopharyngopalatoplasty for severe obstructive sleep apnea hypopnea syndrome[J]. Eur Arch Otorhinolaryngol, 2013, 270(4): 1411-1417. doi:10.1007/s00405-013-2404-5.
[44] Zhao D, Li YR, Xian JF, et al. The combination of anatomy and genioglossus activity in predicting the outcomes of velopharyngeal surgery[J]. Otolaryngol Head Neck Surg, 2017, 156(3): 567-574. doi:10.1177/0194599816686537.
[45] Osnes T, Rollheim J, Hartmann E. Effect of UPPP with respect to site of pharyngeal obstruction in sleep apnoea: follow-up at 18 months by overnight recording of airway pressure and flow[J]. Clin Otolaryngol Allied Sci, 2002, 27(1): 38-43. doi:10.1046/j.0307-7772.2001.00520.x.
[46] 张湘民. 阻塞性睡眠呼吸暂停低通气综合征定位诊断之惑[J]. 山东大学耳鼻喉眼学报, 2017, 31(1): 4-7, 17. doi:10.6040/j.issn.1673-3770.0.2017.007. ZHANG Xiangmin. Localization diagnosis of obstructive sleep apnea hypopnea syndrome[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2017, 31(1): 4-7, 17. doi:10.6040/j.issn.1673-3770.0.2017.007.
[47] Sher AE, Thorpy MJ, Shprintzen RJ, et al. Predictive value of Müller maneuver in selection of patients for uvulopalatopharyngoplasty[J]. Laryngoscope, 1985, 95(12): 1483-1487. doi:10.1288/00005537-198512000-00009.
[48] Petri N, Suadicani P, Wildschiødtz G, et al. Predictive value of Müller maneuver, cephalometry and clinical features for the outcome of uvulopalatopharyngoplasty. Evaluation of predictive factors using discriminant analysis in 30 sleep apnea patients[J]. Acta Otolaryngol, 1994, 114(5): 565-571. doi:10.3109/00016489409126106.
[49] Ritter CT, Trudo FJ, Goldberg AN, et al. Quantitative evaluation of the upper airway during nasopharyngoscopy with the Müller maneuver[J]. Laryngoscope, 1999, 109(6): 954-963. doi:10.1097/00005537-199906000-00022.
[50] Gillespie MB, Reddy RP, White DR, et al. A trial of drug-induced sleep endoscopy in the surgical management of sleep-disordered breathing[J]. Laryngoscope, 2013, 123(1): 277-282. doi:10.1002/lary.23506.
[51] Eichler C, Sommer JU, Stuck BA, et al. Does drug-induced sleep endoscopy change the treatment concept of patients with snoring and obstructive sleep apnea?[J]. Schlaf Atmung, 2013, 17(1): 63-68. doi:10.1007/s11325-012-0647-9.
[52] Iwanaga K, Hasegawa K, Shibata N, et al. Endoscopic examination of obstructive sleep apnea syndrome patients during drug-induced sleep[J]. Acta Otolaryngol Suppl, 2003, 550: 36-40. doi: 10.1080/0365523031000055.
[53] Soares D, Sinawe H, Folbe AJ, et al. Lateral oropharyngeal wall and supraglottic airway collapse associated with failure in sleep apnea surgery[J]. Laryngoscope, 2012, 122(2): 473-479. doi:10.1002/lary.22474.
[54] Koutsourelakis I, Safiruddin F, Ravesloot M, et al. Surgery for obstructive sleep apnea: sleep endoscopy determinants of outcome[J]. Laryngoscope, 2012, 122(11): 2587-2591. doi:10.1002/lary.23462.
[55] Meraj TS, Muenz DG, Glazer TA, et al. Does drug-induced sleep endoscopy predict surgical success in transoral robotic multilevel surgery in obstructive sleep apnea?[J]. Laryngoscope, 2017, 127(4): 971-976. doi:10.1002/lary.26255.
[56] Lee CH, Mo JH, Seo BS, et al. Mouth opening during sleep may be a critical predictor of surgical outcome after uvulopalatopharyngoplasty for obstructive sleep apnea[J]. J Clin Sleep Med, 2010, 6(2): 157-162. 10.1016/j.pnpbp.2010.02.007.
[57] Denolf PL, Vanderveken OM, Marklund ME, et al. The status of cephalometry in the prediction of non-CPAP treatment outcome in obstructive sleep apnea patients[J]. Sleep Med Rev, 2016, 27: 56-73. doi:10.1016/j.smrv.2015.05.009.
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