Hostname: page-component-848d4c4894-jbqgn Total loading time: 0 Render date: 2024-06-24T15:04:51.101Z Has data issue: false hasContentIssue false
  • English
  • Français

Can obstructive sleep apnoea be a complication of uvulopalatopharyngoplasty?

Published online by Cambridge University Press:  29 June 2007

Yehuda Finkelstein ,
Yoav P. Talmi ,
Eyal Raveh ,
Jerome Orlin ,
Carlos Rudnicki ,
Menachem Fried  and
Yzhar Zahavi
Yehuda Finkelstein*
Affiliation:
Departments of Otolaryngology–Head and Neck Surgery, Meir Hospital, Kfar Saba.
Yoav P. Talmi
Affiliation:
Chaim Sheba Medical Center, Tel-Hashomert, Petah Tiqva and Sackler School of Medicine, Tel Aviv University, Israel.
Eyal Raveh
Affiliation:
Beilinson Medical Center, Petah Tiqva, Tel Aviv university, Israel.
Jerome Orlin
Affiliation:
The Hematologic Service, Hasharon Hospital, Golda Medical Centre, Patah Tiqva and Sackler School of Medicine, Tel Aviv University, Israel.
Carlos Rudnicki
Affiliation:
Medicine C' the Cardiologic Service, Petah Tiqva and Sackler School of Medicine, Tel Aviv University, Israel.
Menachem Fried
Affiliation:
Nuclear Cardiologytt, Hasharon Hospital, Golda Medical Centre, Petah Tiqva and Sackler School of Medicine, Tel Aviv University, Israel.
Yzhar Zahavi
Affiliation:
Medicine C' the Cardiologic Service, Petah Tiqva and Sackler School of Medicine, Tel Aviv University, Israel.
*
Address for correspondence: Y. Finkelstein, M.D., Department of otolaryngology—Head and Neck Surgery, Meir Hospital, Kfar Saba, Israel44281. Fax: 972-9-910596
Get access Rights & Permissions [Opens in a new window]

Abstract

Polysomnography is currently used for diagnosis, evaluation and selection of therapy in patients with obstructive sleep apnoea (OSA), but clinically successful uvulopalatopharyngoplasty (UPPP) is not necessarily reflected by post-operative improvement of polysomnographic recordings. Post-operative polysomnography may suggest deterioration of pre-existing OSA or, in snorers, de-novo precipitation of OSA. Thus, if polysomnography is a reliable indicator of OSA, then OSA may be a post-operative risk of UPPP. The aims of our study were: (i) to assess the possible deleterious effect of UPPP on sleep patterns; (ii) to further define the role of cardioisotope scanning in the evaluation of OSA; (iii) to assess the reliability of polysomnography given the clinical and cardioisotope scan findings. Symptoms, polysomnography and radionuclide ventriculography were prospectively compared pre- and post-operatively in 41 patients undergoing UPPP. In 12 patients (29 per cent), there were disparate results between pre- or post-operative polysomnography and the clinical and/or radionuclide ventriculography, as follows: In four of 16 patients with abnormal pre-operative ventricular performance, there was pre-operative symptomatology of severe OSA and a bedmate's reports of apnoeic episodes. This was in contrast to normal or near normal sleep apnoea recordings. In eight patients, post-operative improvement of symptoms was reported, despite deterioration of post-operative polysomnographic recordings. In these patients the post-operative improvement of symptoms was also reflected by improved ventricular performance. Worsening of ventricular performance was not demonstrated in any patient. In conclusion, UPPP does not induce OSA. Polysomnography may underestimate or even misdiagnose cases of OSA. The diagnostic importance of patient symptomatology should be stressed particularly in those patients with only mildly abnormal or even completely normal sleep studies. A combination of polysomnographic and cardiovascular evaluation in patients with symptomatology consistent with OSA is recommended.

Keywords

Sleep apnoea syndromesSnoringPolysomnographyRadionuclide imagingUvula, surgery
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 109 , Issue 3 , March 1995 , pp. 212 - 217
Copyright
Copyright © JLO (1984) Limited 1995

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aber, W. R., Block, A. J., Hellard, D. W., Webb, W. S. (1989) Consistency of respiratory measurements from night to night during the sleep of elderly men. Chest 96: 747–751.CrossRefGoogle ScholarPubMed
Aubert-Tulkins, G., Hamuci, M., Van Den, Eekhaut J., Rodenstein, D. O. (1989) Failure of tonsils and nose surgery in adults with long standing severe sleep apnea syndrome. Archives Internal Medicine 149: 2118–2121.CrossRefGoogle Scholar
Berger, H. J., Johnstone, D. E., Sands, M. J., Gottshalk, A., Zaret, B. L. (1979a) Response of right ventricular ejection fraction to upright bicycle exercise in coronary artery disease. Circulation 60: 1292–1300.CrossRefGoogle ScholarPubMed
Berger, H. J., Reduto, L. A., Johnstone, D. E., Burkowski, H., Sands, J. M., Cohen, L. S., Langou, R. A., Gottschalk, A., Zaret, B. L., Pytlik, L. (1979b) Global and regional left ventricular response to upright bicycle exercise in coronary artery disease. Assessment by quantitative radionuclide angiocardiography. American Journal of Medicine 66: 13–21.CrossRefGoogle Scholar
Berman, E. J., DiBenedetto, R. J., Causey, D. E., Mims, T., Conneff, M., Goodman, L. S., Rollings, R. C. (1991) Right ventricular hypertrophy detected by echocardiography in patients with newly diagnosed obstructive sleep apnea. Chest 100: 347–350.CrossRefGoogle ScholarPubMed
Bliwise, D. L., Carey, E., Dement, W. C., Hultcrantz, I., Boman, G. (1983) Nightly variation in sleep-related respiratory disturbances in older adults. Experimental Aging Research 9: 77–81.CrossRefGoogle ScholarPubMed
Cartwrite, R. (1984) Effect of sleep position on sleep apnea severity. Sleep 7: 110–114.CrossRefGoogle Scholar
Cartwrite, R., Loyd, S., Lilie, G., Kravitz, H. (1985) Sleep position training: treatment for sleep apnoea syndrome. Sleep 8: 87–94.CrossRefGoogle Scholar
Dickson, R. I., Blokmanis, A. (1987) Treatment of obstructive sleep apnea by uvulopalatopharyngoplasty. Laryngoscope 97: 1054–1159.CrossRefGoogle ScholarPubMed
Fairbanks, D. N. F. (1984) Snoring: Surgical versus non surgical management. Larvngoscope 94: 1188–1192.CrossRefGoogle Scholar
Fletcher, E. C., Schaaf, J. W., Miller, J., Fletcher, J. G. (1987) Long term cardiopulmonary sequelae in patients with sleep apnea and chronic lung disease. American Review of Respiratory Disease 135: 525–533.Google ScholarPubMed
Guilleminault, C., Stoohs, R., Clerk, A., Simmons, J., Labanowski, M. (1992) From obstructive sleep apnea syndrome to upper airway resistance syndrome: consistency of daytime sleepiness. Sleep 15 (6 Suppl): 13–16.Google ScholarPubMed
Hillerdal, G., Hetta, J., Lindholm, C. E., Hultcrantz, E., Boman, G. (1991) Symptoms in heavy snorers with and without obstructive sleep apnea. Acta Otolaryngologica (Stockh) 111: 574–581.CrossRefGoogle ScholarPubMed
Lord, S., Sawyer, B., O'Connell, D., King, M., Pond, D., Eyland, A., Mant, A., Holland, J. T., Hensley, M. J., Saunders, N. A. (1991) Night-to-night variability of disturbed breathing during sleep in elderly community sample. Sleep 14: 252–258.Google ScholarPubMed
Lusk, R. P. (1986) Accurate measurement of soft palate resection during uvulopalatopharyngoplasty. Laryngoscope 96: 697–699.CrossRefGoogle Scholar
Mathur, P. N., Powels, P., Pugsley, O., McEwan, M. P., Campbell, E. J. M. (1981) Effect of digoxin on right ventricular function in severe chronic airflow obstruction. Annals of Internal Medicine 95: 283–288.CrossRefGoogle ScholarPubMed
Metes, A., Ohki, M., Cole, P., Haight, J. S. J., Hoffstein, V. (1991) Snoring, apnea and nasal resistance in men and women. Journal of Otolargyngology 20: 57–61.Google ScholarPubMed
Meyer, T. J., Eveloff, S. E., Kline, L. R., Millman, R. P. (1993) One negative polysomnogram does not exclude obstructive sleep apnea. Chest 103: 756–760.CrossRefGoogle Scholar
Mosko, S. S., Dickel, M. J., Ashurst, J. (1988) Night-to-night variability in sleep apnea and sleep-related periodic leg movements in the elderly. Sleep 11: 340–348.Google ScholarPubMed
Pedro-Botet, J., Montaneri, R. A. (1989) Commentaries on the diagnosis and treatment of the chronic ronchopathy with OSAS. 2nd World Congress on Chronic Ronchopathy.BarcelonaMay 22–24.Google Scholar
Pelausa, M. E. D., Tarshis, L. M. (1989) Surgery for snoring. Laryngoscope 99: 1006–1010.CrossRefGoogle ScholarPubMed
Rey, M., Philip-Joet, F., Triglia, J. M., Arnold, P. A. (1989) Effects of uvulopalatopharyngoplasty on polysomnographic data in snorers with sleep apnea syndrome. 2nd World Congress on Chronic Ronchopathy.BarcelonaMay 22–24.Google Scholar
Rice, D. (1986) Snoring. In: Otolaryngologic Clinics of North America (Sataloff, R. T., ed.) W. B. Saunders, Co., Philadelphia, pp 135–140.Google Scholar
Rice, D. H., Persky, M. (1986) Snoring: Clinical implications and treatment. Otolaryngology—Head and Neck Surgery 95: 28–30.CrossRefGoogle ScholarPubMed
Simmons, F. B., Guilleminault, C., Miles, L. E. (1984) The palatopharyngoplasty operation for snoring and sleep apnea: An interim report. Otolaryngology—Head and Neck Surgery 92: 375–380.CrossRefGoogle ScholarPubMed
Stoohs, R., Guilleminault, C. (1991) Snoring during NREM sleep: respiratory timing, esophageal pressure and EEG arousal. Respiratory Physiology 85: 151–167.CrossRefGoogle ScholarPubMed
Tal, A., Lieberman, A., Margulis, G., Sofer, S. (1988) Ventricular dysfunction in children with obstructive sleep apnea: radionuclide assessment. Pediatric Pulmonology 4: 139–143.CrossRefGoogle ScholarPubMed
Zorick, F., Roehrs, R., Conway, W., Fujita, S., Witting, R., Roth, T. (1983) Effects of uvulopalatopharyngoplasty on the daytime sleepiness associated with sleep aponea syndrome. European Respiratory Journal (Formerly: Bull Eur Physiopathol Respir) 19: 600–603.Google Scholar
Zohar, Y., Talmi, Y. P., Frenkel, H., Finkelstein, Y, Rudniki, C., Fried, M., Zahavi, Y. (1992) Cardiac sequela in obstructive sleep apnea patients following uvulopalatopharyngoplasty. Otolaryngology—Head and Neck Surgery 107: 390–394.CrossRefGoogle Scholar
Witting, R. M., Romaker, A., Zorick, F. J., Roehers, T. A., Conway, W. A., Roth, T. (1984) Night-to-night consistency of apneas during sleep. American Revue of Respiratory Disease 129: 244–246.Google Scholar