Elective tracheostomy is an alternative treatment in patients with severe obstructive sleep apnoea syndrome and CPAP failure

Abstract

Conclusions: Elective tracheostomy with custom-made tubes was tolerated in a majority of patients with severe obstructive sleep apnoea syndrome (OSAS), as it reduced daytime symptoms and served as a link to other treatments.

Objectives: To evaluate the tolerability of elective tracheostomy and changes in excessive daytime sleepiness and nocturnal oxygen desaturations (ODI) in patients with severe OSAS and obesity.

Patients and methods: The medical records of 10 patients, median age 53.5 years (range 31-77), BMI 36 kg/m(2) (31-50), ODI 81 (55-126) during a 5-year period were reviewed. Inclusion criteria were failure of continuous positive airway pressure (CPAP), acceptance of tracheostomy, excessive daytime sleepiness and ODI > 50. All patients received a custom-made tube. Sleep apnoea recordings and questionnaires with Epworth sleepiness scale (ESS) were performed before and after tracheostomy.

Results: Eight of 10 patients tolerated the tube for more than 6 months. The ESS score was reduced from median 18 (range 8-23) to 5 (0-7) and the ODI values from 81 (55-126) to 13 (1-87). Two patients insisted on decannulation because they had nocturnal breathing problems, two underwent palatal surgery and were decannulated, and five still have their tubes. Severe cough, sputum infections and stoma granuloma were seen in all patients.