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Ağır Obstrüktif Uyku Apne Sendromlu Hastalarda Tek Aşamalı Çok Seviyeli Cerrahi

Single-Stage Multilevel Upper Airway Surgery in Patients with Severe Obstructive Sleep Apnea Syndrome

Journal Name:

  • Akdeniz Tıp Dergisi

Publication Year:

  • 2015
DOI: 
10.17954/amj.2015.28

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Objective: The aim of this study was to investigate the effi cacy of single–stage multilevel upper airway surgery including modifi ed tongue base suspension (mTBS) combined with uvulopharyngopalatoplasty (UPPP) in patients with severe obstructive sleep apnea syndrome (OSAS). Material and Methods: This prospective case series includes a total of 50 OSAS patients who had an apnea–hypopnea index (AHI) >30 with oropharyngeal and/or hypopharyngeal obstruction, and rejected continuous positive airway pressure (CPAP) therapy. Polysomnography was performed in all subjects preoperatively and at the sixth postoperative month. The surgery was considered to be successful when a ≥50% reduction was obtained in the preoperative AHI and a postoperative AHI of <20/hour. Results: The mean age and body mass index of the patients were 47.5±8.6 years and 31.2±2.8 kg/m², respectively. At the postoperative sixth month, a signifi cant improvement was observed in all patients in terms of the severity and number of obstructive events (AHI, arousal index, number of obstructive apneas and hypopneas, O2 desaturation index), oxygenization values (minimum and mean O2 saturation, mean O2 desaturation) and sleep architecture (total sleep time, sleep effi ciency, sleep latancy, sleep stages) (P<0.05). In total, 37 patients (74.0%) met the surgical success criteria.Patients were stratifi ed into two groups according to their surgical outcome (successful/unsuccessful), and the main preoperative and postoperative oxygenization parameters were compared again. There were statistically signifi cant improvements in all oxymetric values in patients in the successful group (P<0.001) whereas the values of mean O2 desaturation and O2 desaturation index did not differ postoperatively (P=0.590 and P=0.208, respectively) in patients in the unsuccessful group,. Conclusion: Single–stage multilevel upper airway surgery including mTBS combined with UPPP is a highly effective procedure in well–selected patients with OSAS.
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Abstract (Original Language): 
Amaç: Çalışmanın amacı ağır obstrüktif uyku apne sendromlu (OSAS) hastalarda uvulofaringopalatoplasti (UPPP) ile kombine edilmiş modifi ye dil kökü askısını içeren tek aşamalı çok seviyeli üst hava yolu cerrahisinin etkinliğini araştırmaktır. Gereç ve Yöntemler: Bu prospektif olgu serisi apne–hipopne indeksi (AHI)>30 olan, orofarengeal ve/veya hipofarengeal obstrüksiyonu olan ve sürekli pozitif hava yolu basıncı – CPAP tedavisini reddeden toplam 50 OSAS hastasını içermektedir. Tüm hastalara preoperatif ve postoperatif altıncı ayda polisomnografi uygulandı. Preoperatif AHI’ de ≥%50 azalma ile birlikte <20/saat postoperatif AHI elde edilmesi halinde, cerrahi başarılı olarak kabul edildi. Bulgular: Hastaların ortalama yaş ve vücut kitle indeksi sırasıyla 47,5±8,6 yıl ve 31,2±2,8 kg/m² idi. Postoperatif altıncı ayda hastaların tamamında obstrüktif olayların şiddeti ve sayısında (AHI, arousal indeksi, obstrüktif apne ve hipopne sayısı, O2 desatürasyon indeksi), oksijenizasyon değerlerinde (minimum ve ortalama O2 satürasyonu, ortalama O2 desatürasyonu) ve uyku mimarisinde (toplam uyku süresi, uyku etkinliği, uyku latansı, uyku evreleri) belirgin düzelme izlendi (P<0,05). Toplam 37 hasta (%74,0) cerrahi başarı kriterini karşıladı. Hastalar cerrahi sonuçlara göre (başarılı/başarısız) iki gruba ayrılarak başlıca preoperatif ve postoperatif oksijenizasyon parametreleri yeniden karşılaştırıldı. Başarılı gruptaki hastalarda, tüm oksimetrik değerlerde istatistiksel olarak anlamlı düzelme saptanırken (P<0,001), başarısız gruptaki hastalarda ise ortalama O2 desatürasyonu ve O2 desatürasyon indeksi değerleri postoperatif dönemde değişmedi (sırasıyla P = 0,590, P = 0,208). Sonuç: UPPP ile kombine edilmiş modifi ye dil kökü askısını içeren tek aşamalı çok seviyeli üst hava yolu cerrahisi iyi seçilmiş ağır OSAS’lı hastalarda oldukça etkili bir prosedürdür.
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  • 3
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  • Turkish

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