[Treating obstructive sleep apnea with nasal operation and revised uvulopalatopharyngoplasty].

OBJECTIVE

Nasal operation and/or H-uvulopalatopharyngoplasty (UPPP) was performed for obstructive sleep apnea hypopnea syndrome (OSAHS) patients with both oral pharynx and nasal obstruction, results analyzed.

METHODS

Patients were divided into group A (46 cases) and group B (42 case) randomly. Nasal procedures were: septoplasty, radiofrequency reduction of inferior turbinate, adenoidectomy and functional endoscopic operation. Cases in group A had nasal operation first, while cases in group B first had UPPP. All patients had sleep study with polysomnography (PSG) 2 and 12 months after each operation. Those who failed to reach the criteria of being effective after first surgery (defined as a 25% reduction in baseline apnea hypopnea index (AHI) received second phase operation (nasal operation for group B and UPPP for group A). The response rates were compared between the two groups after each phase of operation.

RESULTS

In group A, the phase one operation were effective in 44.0% (11/25) for the mild degree OSAHS patients (defined as AHI < 20/h), according to the sleep study performed 2 months after surgery, and no recurrence after one-year. All moderate ones (defined as 20/h < AHI < 40/h) responded poorly to nasal operation. The overall response rate was 23.9% (11/46). Non-responses (35 cases) in group A underwent UPPP and the response rate to it was 85.7% (30/35) in one year. In group B, UPPP operation was effective in 63.6% (14/22) mild cases and 30.0% (6/20) moderate cases in 2 months but 4 cases had recurrence in one year. Twenty-two cases underwent the second phase operation of nose and the response rate was 86.4% (19/22) in one year. There was no statistical significance on the overall response rate between group A and B (89.1% vs 83.3%, P > 0.05). While there was statistical significance of response rate between those patients who had only one operation and those who had both surgeries (P < 0.05).

CONCLUSIONS

The combination of nasal procedures and UPPP is effective a for OSAHS patient with nasal diseases especially in mild and moderate cases.