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Journal of Peking University (Health Sciences) ›› 2020, Vol. 52 ›› Issue (2): 281-284. doi: 10.19723/j.issn.1671-167X.2020.02.014

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Predictive values of the combination of Friedman stage and sleep oximetry done early after surgery in predicting the treatment outcomes of uvulopalatopharyngoplasty

Bing-wan DONG,Jun-bo ZHANG,Shui-fang XIAO()   

  1. Department of Otorhinolaryngology Head and Neck Surgery, Peking University First Hospital, Beijing 100034, China
  • Received:2019-08-19 Online:2020-04-18 Published:2020-04-18
  • Contact: Shui-fang XIAO E-mail:xiao_ent@163.com

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Abstract:

Objective: To explore the predictive values of the combination of preoperative data, including medical history and physical examination, and results of sleep oximetry performed early after the surgery (one week) in predicting the treatment outcomes of uvulopalatopharyngoplasty (UPPP) in adult patients with obstructive sleep apnea hypopnea syndrome (OSAHS).Methods: All the patients who were diagnosed with OSAHS, underwent UPPP treatment and had complete follow-up data in our institution between Jan 2013 and May 2016 were enrolled in our study. The pre-operative data of these patients, including age, physical examination, and polysomnography (PSG) data, were all exactly collected for analysis. All these patients had received the evaluation of subjective efficacy scale and the sleep oximetry test in early post-operative days (within one week). The long-term efficacy evaluations including PSG and subjective efficacy scale were all finished at least three months after the surgery.Results: In the research 61 patients were finally studied, including 25 responders (41.0%) and 36 non-responders (59.0%). Regression analysis revealed that the pre-operative Friedman stage and early post-operative oxygen desaturation index of ≥4% (ODI4) were found to be independently predictive parameters for the UPPP treatment outcomes (P<0.05). The ROC curve analysis was used to estimate the predictive values of ODI4 to the treatment outcomes, and it was calculated with an area under the curve of 0.822. Using the ODI4 of 15 as the cutoff value, the sensitivity and specificity of that calculated were up to 0.778 and 0.760 respectively. The response rate among the patients with an early post-operative ODI4 of <15 was 70.4%, which was significantly higher than that of the patients with an early post-operative ODI4 of ≥15, whose response rate was 17.6% (P<0.05). The similar results could also be obtained in the patients with pre-operative Friedman stage Ⅱ (87.5% vs.25.0%) and Friedman stage Ⅲ (33.3% vs. 6.7%).Conclusion: The combination of early post UPPP operation oximetry parameters, especially ODI4, and pre-operative Friedman stage could be used in better evaluating the potential surgical outcomes of UPPP.

Key words: Obstructive sleep apnea hypopnea syndrome, Friedman stage, Oxygen desaturation index, Uvulopalatopharyngoplasty

CLC Number: 

  • R766.9

Table 1

The clinical data of responders and non-responders"

Items All(n=61) Responders group(n=25) Non-responders group(n=36) t or Chi-square P
Age/years 43.5±9.4 44.3±11.2 42.9±8.1 -0.542 0.590
BMI/(kg/m2) 28.9±3.5 28.5±3.2 29.1±3.7 0.704 0.484
ESS 8.1±3.7 7.2±3.8 8.7±3.6 1.596 0.116
Friedman stage 9.673 0.002*
Type Ⅰto Ⅱ 37 21 16
Type Ⅲ 24 4 20
Preoperative PSG
AHI/(/h) 55.6±21.2 51.0±20.5 58.8±21.4 1.421 0.161
LSAT/% 70.7±11.1 74.3±10.4 68.1±11.1 -2.188 0.033*
CT90/% 24.1±24.4 18.8±22.2 27.8±25.5 1.432 0.157
Early post-operative sleep oximetry test
ODI3/(/h) 28.0±20.7 15.0±10.5 37.1±21.3 5.347 <0.001*
ODI4/(/h) 22.9±18.5 10.9±8.0 31.1±19.2 5.663 <0.001*
LSAT/% 76.3±8.9 80.2±7.7 73.6±8.7 -3.072 0.003*
VAS scale
Early stage 6.2±2.2 6.8±2.0 5.8±2.3 -1.842 0.070
Long-term 7.2±1.5 7.6±1.5 7.0±1.5 -1.526 0.132

Figure 1

The predictive values of ODI4 to long-term efficacy, the area under the curve 0.822"

Figure 2

The combination of early post-operation ODI4 and Friedman stage could be better in evaluating the potentialsurgical outcomes of UPPP, the efficacy varied as ODI4 differed in patients of Friedman Ⅱ and Ⅲ"

[1] 中国医师协会睡眠医学专业委员会. 成人阻塞性睡眠暂停多学科诊疗指南[J]. 中华医学杂志, 2018,98(24):1902-1914.
[2] Borowiecki BD, Sassin JF . Surgical treatment of sleep apnea[J]. Arch Otolaryngol, 1983,109(8):506-512.
[3] Friedman M, Landsberg R, Tanyeri H . Submucosal uvulopalatopharyngoplasty[J]. Otolaryngol Head Neck Surg, 2000,11(1):26-29.
[4] Friedman M, Ibrahim H, Joseph NJ . Staging of obstructive sleep apnea/hypopnea syndrome: a guide to appromiate treatment[J]. Laryngoscope, 2004,114(3):454-459.
[5] Friedman M ,I brahim H, Bass L.Clinical staging for sleep-disordered breathing[J]. Otolaryngol Head Neck Surg, 2002,127(1):13-21.
[6] Liu JM, Yi B, Ye JY . Combination of transpalatal advancement pharyngoplasty and H-uvulopalatopharyngoplasty for obstructive sleep apnea[J]. Oper Tech Otolayngol Head Neck Surg, 2009,20(2):152-158.
[7] Iwanaga K, Hasegawa K, Shibata N , et al. Endoscopic examination of obstructive sleep apnea syndrome patients during drug-induced sleep[J].Acta Otolaryngol Suppl, 2003(550):36-40.
[8] Sanders MH, Johnson JT, Keller F , et al. The acute effects of uvulopalatopharyngoplasty on breathing during sleep in sleep apnea patients[J]. Sleep, 1988,11(1):75-89.
[9] Weaver EM, Woodson BT, Yueh B , et al. Studying life effect & effectiveness of palatopharyngoplasty (SLEEP) study: subjective outcomes of isolated uvulopalatopharyngoplasty[J]. Otolaryngol Head Neck Surg, 2011,144(4):623-631.
[10] Kezirian EJ, Weaver EM, Criswell MA , et al. Reporting results of obstructive sleep apnea syndrome surgery trials[J]. Otolaryngol Head Neck Surg, 2011,144(4):496-499.
[11] Dickson RI, Blokmanis A . Treatment of obstructive sleep apnea by uvulopalatopharyngoplasty[J]. Laryngoscope, 1987,97(9):1054-1059.
[12] Corcoran S, Mysliwiec V, Niven AS , et al. Development of central sleep apnea after maxillofacial surgery for obstructive sleep apnea[J]. J Clin Sleep Med, 2009,5(2):151-153.
[13] Sanders MH, Costantino JP, Johnson JT . Polysomnography early after uvulopalatopharyngoplasty as a predictor of late postoperative results[J]. Chest, 1990,97(4):913-919.
[14] Zhang JB, Li YR, Cao X , et al. The combination of anatomy and physiology in predicting the outcomes of velopharyngeal surgery[J]. Laryngoscope, 2014,124:1718-1723.
[15] He M . Long-term efficacy of uvulopalatopharyngoplasty among adult patients with obstructive sleep apnea: a systematic review and meta-analysis[J]. Otolaryngol Head Neck Surg, 2019,161(3):401-411.
[16] Choi JH, Cho SH, Kim SN , et al. Predicting outcomes after Uvulopalatopharyngoplasty for adult obstructive sleep apnea: a meta-analysis[J]. Otolaryngol Head Neck Surg, 2016,155(6):904-913.
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