[Practicability of a surgical multilevel therapy in patients with obstructive sleep apnea]

Abstract

Background: Obstructive sleep apnea syndrome is a "systemic disease" of the upper airways and the upper digestive tract. The concept of multilevel surgery takes account of the fact that the location of the obstruction frequently cannot be identified precisely.

Patients and methods: In this retrospective study over 4 years, data on 25 patients (median age 49.9 years) with moderate to severe OSAS treated with a surgical multilevel therapy were statistically evaluated. The treatment carried out consisted in reduction of the inferior turbinate, if necessary combined with septum plasty, and conventional uvulopalatopharyngoplasty (UPPP), combined with tonsillectomy and radiofrequency therapy of the base of the tongue if appropriate. Pre- and postoperative clinical and polysomnographical checks were performed.

Results: The mean apnea-hypopnea index (AHI) was 39.2+/-19.7/h before surgery. Postoperatively a highly significant reduction of AHI to 16.5+/-9.9/h (p<0.0001) was seen. In 13 out of 25 patients (52%) the disease was cured (AHI<20 and 50% reduction). In 23 patients the AHI improved. In 15 patients AHI was reduced by more than 50%.

Conclusion: Multilevel surgery should be considered as an alternative for patients suffering from OSAS, especially in view of the poor long-term results in patients who receive CPAP therapy or are intolerant to CPAP.