Polysomnographic Outcomes Before and After Skeletal
Surgeries for the Treatment of Obstructive Sleep Apnea
Kanyarat Khamproh MD¹, Wish Banhiran MD², Wattanachai Chotinaiwattarakul MD³, Phawin Keskool MD², Sarin Rungmanee MD⁴, Surintorn Wongvilairat MD⁵
Affiliation : ¹ Fort Suranari Hospital, Nakhon Ratchasima, Thailand ² Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ³ Division of Neurology, Department of Internal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ⁴ Siriraj Sleep Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ⁵ Somdej Phrachao Taksin Maharat Hospital, Tak, Thailand
Objective : To evaluate polysomnographic (PSG) outcomes after common skeletal surgeries for the treatment of obstructive sleep apnea (OSA)
in Thai patients.
Materials and Methods : The retrospective study included OSA patients aged 18 years and older treated by hyoid suspension (HS) plus uvulopalatopharyngoplasty (UPPP) (Group 1), genioglossus advancement (GA) plus tongue base radiofrequency (TBRF) (Group 2), and maxillomandibular advancement (MMA) (Group 3) at Siriraj Hospital between January 2007 and October 2018. Those with incomplete PSG data were excluded. The primary outcome was the apnea-hypopnea index (AHI). Secondary outcomes were other PSG parameters and postoperative complications.
Results : Twenty-four patients including 22 males and 2 females were included. Group1 (n=11), median AHI decreased from 45.4 to 24.1 events/ hour (p=0.17), while lowest oxygen saturation (LSAT) changed from 72.0% to 71.0% (p=0.11). Group2 (n=3) median AHI decreased from 64.7 to 51.4 events/hour (p=0.11), LSAT increased from 76.0% to 79.0% (p=1.0), and rapid eye movement (REM) sleep increased from 0.0% to 12.4% (p=0.11). Group3 (n=12) median AHI decreased from 68.5 to 7.8 events/hour (p<0.002), LSAT increased from 75.5% to 88.0% (p=0.04), and REM increased from 0.0% to 21.5% (p=0.01). Surgical success rates as defined by Sher’s criteria or a postoperative AHI of less than five events/ hour were 44.4%, 33.3%, and 66.6% in patients in groups 1, 2, and 3, respectively. Common surgical complications included bleeding, mental or perioral paresthesia, and malocclusion after MMA.
Conclusion : The skeletal surgeries significantly improved some PSG parameters, and thus may be viable options for OSA treatment in Thai patients.
Received 28 August 2020 | Revised 29 October 2020 | Accepted 29 October 2020
doi.org/10.35755/jmedassocthai.2021.03.11906
Keywords :
Keywords : Obstructive sleep apnea, Skeletal surgery, Hyoid suspension, Genioglossus advancement, Maxillomandibular advancement, Thai
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