Post-Operative Sleep Endoscopy with Target-Controlled Infusion After Palatopharyngoplasty for Obstructive Sleep Apnea: Anatomical and Polysomnographic Outcomes

Abstract

Feng-Hsiang Chiu,1,2 Yi Chang,3 Wen-Wei Liao,3 Yu-Ling Yeh,3 Chia-Mo Lin,4– 6 Ofer Jacobowitz,7 Ying-Shuo Hsu8,9 1Department of Otolaryngology, Head and Neck Surgery, Tri-service General Hospital, Taipei, Taiwan; 2National Defense Medical Center, Taipei City, Taiwan; 3Department of Anesthesiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; 4Division of Chest Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; 5Department of Chemistry, Fu-Jen Catholic University, New Taipei City, Taiwan; 6Graduate Institute of Biomedical and Pharmaceutical Science, Fu Jen Catholic University, New Taipei City, Taiwan; 7ENT & Allergy Associates, New York, NY, USA; 8Department of Otolaryngology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; 9School of Medicine, Fu Jen Catholic University, New Taipei City, TaiwanCorrespondence: Ofer JacobowitzENT & Allergy Associates, New York, NY, USATel [phone]Email [email protected] HsuDepartment of Otolaryngology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, TaiwanTel [phone] ext.2551Email [email protected]: The findings of drug-induced sleep endoscopy (DISE) are not always correlated with the outcome of upper airway surgery for obstructive sleep apnea (OSA), and whether multilevel surgery is truly required in treating multilevel obstruction identified in preoperative DISE remains an issue. We attempted to compare DISE findings before and after palatopharyngoplasty in patients with OSA because changes in DISE may be beneficial to better understand polysomnographic and anatomical outcomes.Methods: This was a prospective cohort study for 34 patients with moderate to severe OSA who underwent palatopharyngoplasty at a tertiary care center from 2016 to 2018. We recorded the patients’ demographic characteristics, procedures, and surgical outcomes and compared the preoperative and postoperative DISE staging patterns.Results: The apnea-hypopnea index (AHI) values of 34 adults improved significantly after surgery (40.6 ± 23.3 versus 25.6 ± 20.6, P < 0.001). The majority of patients, 26/34, had preoperative complete concentric collapse at the velum, and for most (20/26, 77%) there was a change of the collapse pattern into anteroposterior collapse postoperatively. Patients with postoperative velar collapse had higher follow-up AHI values than those who without (27.8 ± 21.9 versus 15.2 ± 7.7, P = 0.023). Patients with preoperative complete tongue base collapse had higher follow-up AHI values than did those with no or partial collapse (40.6 ± 21.0 versus 21.0 ± 18.6, P = 0.017). Patients with postoperative complete tongue base collapse also had higher follow-up AHI values than the others (42.7 ± 22.1 versus 18.5 ± 15.4, P = 0.001).Conclusion: Palatopharyngoplasty could change the collapse pattern at the velum in most patients. Preoperative and postoperative complete tongue base collapse and postoperative velar collapse identified in TCI-DISE were associated with relatively poor outcomes.Keywords: obstructive sleep apnea, drug-induced sleep endoscopy, palatopharyngoplasty, postoperative, complete concentric collapse, tongue base collapse

Keywords

• obstructive sleep apnea
• drug-induced sleep endoscopy
• palatopharyngoplasty
• postoperative
• complete concentric collapse
• tongue base collapse