[Preoperative nasal continuous positive airway pressure treatment as substitute for protective tracheostomy in severe obstructive sleep apnea syndrome].

OBJECTIVE

Preoperative nasal continuous positive airway pressure(NCPAP) treatment was used as a substitute for protective tracheostomy before UPPP surgery in 42 patients with severe obstructive sleep apnea syndrome(OSAS) from 1994 to 1996.

METHODS

Fifty-two patients operated on three years before this period served as control group. All cases were diagnosed as severe OSAS by polysomnography (PSC).

RESULTS

There were no statistical difference in main parameters between two groups. Seven cases in the control group underwent protective tracheostomy whose apnea and hypopnea index(AHI) was 28.4-83.5 and lowest saturation oxygen (SaO2) were 7%-32%. One patient underwent emergency tracheostomy due to life-threatening situation during uvulopalatopharyngoplasty (UPPP). There were 9 similarly severe cases who did not undergo protective tracheostomy in NCPAP treatment group. All patients underwent preoperative 5-20 day NCPAP treatment in treatment group. The average positive pressure was 1.16 kPa(11.85 cmH2O). There were significant difference in main parameters between the two groups. The AHI, SaO2 and sleep structure were evidently improved. UPPP was safely performed without protective tracheostomy and any complications in all patients with NCPAP treatment.

CONCLUSION

This result implys that NCPAP treatment could be used as a substitute for protective tracheostomy before UPPP in severe OSAS.