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European Archives of Oto-Rhino-Laryngology

, Volume 268, Issue 11, pp 1679–1685 | Cite as

Statistical model for postoperative apnea–hypopnea index after multilevel surgery for sleep-disordered breathing

  • Kurt Tschopp
  • Thomas Zumbrunn
  • Christoph Knaus
  • Esther Thomaser
  • Thomas Fabbro
Miscellaneous

Abstract

The objective of the study was to formulate a statistical model for postoperative apnea–hypopnea index (AHI) 3 and 12 months after multilevel surgery using the predictors preoperative AHI, body mass index (BMI) and age. The study design was a prospective cohort study. Data of 144 patients were collected prospectively 3 and 12 months after multilevel surgery for obstructive sleep apnea syndrome (OSAS) or upper airway resistance syndrome with excessive daytime sleepiness. The primary endpoint postoperative AHI and the secondary endpoint success according to the Sher criteria (postoperative AHI <20 h and >50% reduction of preoperative AHI) were modeled with multiple linear and logistic regression using the predictors preoperative AHI, BMI, age and the indicator whether the patient had undergone a tonsillectomy. Preoperative AHI and tonsillectomy had a highly significant positive influence on postoperative AHI after 3 months, whereas the influence of preoperative BMI was only marginally significant but numerically rather large. Age was not a significant decisive factor. The success according to the Sher criteria was highly significantly determined by the circumstance whether the patient had undergone a tonsillectomy, but not by the other predictors preoperative BMI or age. The responder rate with and without tonsillectomy was 58 and 19%, respectively. The odds ratio to be a responder if a tonsillectomy was conducted was 5.7. This study provides statistical models predicting postoperative AHI and success according to the Sher criteria after multilevel surgery for OSAS.

Keywords

Statistical prediction model Obstructive sleep apnea syndrome (OSAS) Multilevel surgery Apnea–hypopnea index (AHI) Body mass index (BMI) Age Tonsillectomy Sher criteria 

Notes

Acknowledgments

The study was approved by the ethics committee of Basel.

Conflict of interest

None.

References

  1. 1.
    Aloia MS, Stanchina M, Arnedt JT, Malhotra A, Millman RP (2005) Treatment adherence and outcomes in flexible vs. standard continuous positive airway pressure therapy. Chest 127(6):2085–2093PubMedCrossRefGoogle Scholar
  2. 2.
    Doherty LS, Kiely JL, Swan V, McNicholas WT (2005) Long-term effects of nasal continuous positive airway pressure therapy on cardiovascular outcomes in sleep apnea syndrome. Chest 127(6):2076–2084PubMedCrossRefGoogle Scholar
  3. 3.
    Jokic R, Klimaszewski A, Crossley M, Sridhar G, Fitzpatrick MF (1999) Positional treatment vs continuous positive airway pressure in patients with positional obstructive sleep apnea syndrome. Chest 115:771–781PubMedCrossRefGoogle Scholar
  4. 4.
    Petri N, Svanholt P, Solow B, WildschiØdtz G, Winkel P (2008) Mandibular advancement appliance for obstructive sleep apnea: results of a randomised placebo controlled trial using parallel group design. J Sleep Res 17:220–221CrossRefGoogle Scholar
  5. 5.
    Tschopp K, Thomaser EG, Staub C (2009) Therapy of snoring and obstructive sleep apnea using the Velumount® palatal device. ORL 71:148–152PubMedCrossRefGoogle Scholar
  6. 6.
    Boudewyns AN, Van de Heyning PH, De Backer WA (1997) Site of upper airway obstruction in obstructive apnea and influence of sleep stage. Eur Respir J 10:2566–2572PubMedCrossRefGoogle Scholar
  7. 7.
    Verse T, Baisch A, Maurer JT, Stuck BA, Hörmann K (2006) Multi-level surgery for obstructive sleep apnea: short-term results. Otolaryngol Head Neck Surg 134:571–577PubMedCrossRefGoogle Scholar
  8. 8.
    Friedman M, Lin HC, Gurpinar B, Joseph NJ (2007) Minimally invasive single-stage multilevel treatment for obstructive sleep apnea/hypopnea syndrome. Laryngoscope 117:1859–1863PubMedCrossRefGoogle Scholar
  9. 9.
    Verse T (2008) Update on surgery for obstructive sleep apnea syndrome. HNO 56:1098–1104PubMedCrossRefGoogle Scholar
  10. 10.
    Lin HC, Friedman M, Chang HW, Gurpinar B (2008) The efficacy of multilevel surgery of the upper airway in adults with obstructive sleep apnea/hypopnea syndrome. Laryngoscope 118:902–909PubMedCrossRefGoogle Scholar
  11. 11.
    Sher AE, Schechtmann KB, Piccirillo JF (1996) The efficiency of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep 19:156–177PubMedGoogle Scholar
  12. 12.
    Tschopp K (2007) Modification of the Hoermann technique of hyoid suspension in obstructive sleep apnea. J Laryngol Otol 121:491–493PubMedCrossRefGoogle Scholar
  13. 13.
    R Development Core Team (2009) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. http://www.R-project.org
  14. 14.
    Maurer JT (2009) Update on surgical treatment for sleep apnoea. Swiss Med Wkly 139(43–44):624–629PubMedGoogle Scholar
  15. 15.
    Benazzo M, Pagella F, Matti E, Zorzi S, Campanini A, Frassineti S, Montevecchi F, Tinelli C, Vicini C (2008) Hyoidthyroidpexia as a treatment in multilevel surgery for obstructive sleep apnea. Acta Otolaryngol 128:680–684PubMedCrossRefGoogle Scholar
  16. 16.
    Verse T, Kroker BA, Pirsig W, Brosch S (2000) Tonsillectomy as a treatment of obstructive sleep apnea in adults with tonsillar hypertrophy. Laryngoscope 110:1556–1559PubMedCrossRefGoogle Scholar
  17. 17.
    Li HY, Wang PC, Lee LA, Chen NH, Fang TJ (2006) Prediction of uvulopalatopharyngoplasty outcome: anatomy-based staging system versus severity-based staging system. Sleep 29:1537–1541PubMedGoogle Scholar
  18. 18.
    Andsberg U, Jessen M (2000) Eight years of follow-up-uvulopalatopharyngoplasty combined with midline glossectomy as a treatment for obstructive sleep apnea syndrome. Acta Otolaryngol Suppl 543:175–178PubMedCrossRefGoogle Scholar
  19. 19.
    Neruntarat C (2003) Genioglossus advancement and hyoid myotomy: short-term and long-term results. J Laryngol Otol 117:482–486PubMedCrossRefGoogle Scholar
  20. 20.
    Riley RW, Powell NB, Guilleminault C (1994) Obstructive sleep apnea syndrome and the hyoid: a revised surgical procedure. Otolaryngol Head Neck Surg 111:717–721PubMedCrossRefGoogle Scholar
  21. 21.
    Den Herder C, van Tinteren H, de Vries N (2005) Hyoidthyroidpexia: a surgical treatment for sleep apnea syndrome. Laryngoscope 115:740–745CrossRefGoogle Scholar
  22. 22.
    Friedman M, Ibrahim H, Lee G, Joseph N (2003) Combined uvulopalatopharyngoplasty and radiofrequency tongue base reduction for treatment of obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surg 129:611–621PubMedCrossRefGoogle Scholar
  23. 23.
    Powell NB, Riley RW, Guilleminault C (1999) Radiofrequency tongue base reduction in sleep-disordered breathing: a pilot study. Otolaryngol Head Neck Surg 120:656–664PubMedCrossRefGoogle Scholar
  24. 24.
    Fernández-Julián E, Muñoz N, Achiques MT, García-Pérez MA, Orts M, Marco J (2009) Randomized study comparing two tongue base surgeries for moderate to severe obstructive sleep apnea syndrome. Otolaryngol Head Neck Surg 140:917–923PubMedCrossRefGoogle Scholar
  25. 25.
    Foltán R, Hoffmannová J, Pretl M, Donev F, Vlk M (2007) Genioglossus advancement and hyoid myotomy in treating obstructive sleep apnea syndrome: a follow-up study. J Craniomaxilofac Surg 35:246–251CrossRefGoogle Scholar
  26. 26.
    Richard W, Kox D, den Herder C, van Tinteren H, de Vries N (2007) One stage multilevel surgery (uvulopalatopharyngoplasty, hyoid suspension, radiofrequent ablation of the tongue base with/without genioglossus advancement) in obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol 264:439–444PubMedCrossRefGoogle Scholar
  27. 27.
    Bowden MT, Keziran EJ, Utley D, Goode RL (2005) Outcomes of hyoid suspension for the treatment of obstructive sleep apnea. Arch Otolaryngol Head Neck Surg 131:440–445PubMedCrossRefGoogle Scholar
  28. 28.
    Keziran EJ, Goldberg AN (2006) Hypopharyngeal surgery in obstructive sleep apnea: an evidence-based medicine review. Arch Otolaryngol Head Neck Surg 132:206–213CrossRefGoogle Scholar
  29. 29.
    Blaker H (2000) Confidence curves and improved exact confidence intervals for discrete distributions. Can J Stat 28:783–798CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Kurt Tschopp
    • 1
  • Thomas Zumbrunn
    • 2
  • Christoph Knaus
    • 1
  • Esther Thomaser
    • 1
  • Thomas Fabbro
    • 2
  1. 1.ENT Clinic, Cantonal Hospital LiestalLiestalSwitzerland
  2. 2.Clinical Trial UnitUniversity Hospital BaselBaselSwitzerland

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