Results of Tailor-Made Multilevel Surgery in Patients with Obstructive Sleep Apnea

Abstract

Background and Objective The concept of tailor-made, multilevel surgery, including the nasal cavity, a multiple level of the pharynx, should be required to overcome the collapse at multiple levels of the upper airway because most patients show multilevel airway obstruction. The objective of this study was to evaluate the surgical results when the surgery was performed at the multilevel of the pharynx and in a tailor-made manner in obstructive sleep apnea (OSA) patients with multilevel obstruction in various evaluations of the obstruction site. Methods This is a retrospective analysis of data prospectively gathered on 86 OSA patients treated with multilevel surgery. Patients were evaluated with a questionnaire preoperatively and postoperatively at 1 month and more than 6 months, respectively. A polysomnography was used to evaluate the surgical results postoperatively at more than 6 months. Results Postoperative values for the questionnaire of both daytime and nighttime symptoms were significantly reduced after surgery. Daytime sleepiness checked by Epworth Sleepiness Scale (ESS) was significantly improved. The postoperative value of apnea-hypopnea index (AHI) was significantly improved after treatment. When the successful outcome was defined as a postoperative AHI < 5, 43.3% of patients met the criteria. The success rates of surgery among the groups according to severity were not statistically significant. Conclusions Multilevel surgery in a tailor-made manner shows relatively good results. This can be a solution for OSA patients when medical therapy, including nasal continuous positive airway pressure, is not tolerable. Precise and tenacious evaluation of the obstruction site is the key for increasing surgical success.

Keywords

• Obstructive sleep apnea
• Surgery
• Multilevel treatment