Complete concentric collapse at the soft palate in sleep endoscopy: what change is possible after UPPP in patients with CPAP failure?

  • Katrin Hasselbacher
  • A. Seitz
  • N. Abrams
  • B. Wollenberg
  • A. Steffen
Sleep Breathing Physiology and Disorders • Original Article
  • 8 Downloads

Abstract

Purpose

The aim of this work was to assess whether uvulopalatopharyngoplasty in patients with failure for positive airway pressure not only reduces the degree of obstructive sleep apnea but also to determine as well if it changes the collapse pattern of the soft palate and thereby fulfills the qualifications for implementing upper airway stimulation (UAS) as an adjunctive solution.

Method

Fifteen patients with intolerance for positive airway pressure were included in this retrospective cohort study. Polygraphy and drug-induced sleep endoscopy were used in order to evaluate the reduction of the apnea-hypopnea index (AHI), as well as the change of collapse pattern at the soft palate level before and about 3 months after uvulopalatopharyngoplasty and tonsillectomy (TE-UPPP).

Results

In 93% of the patients, a postoperative change of the initially complete concentric palatal collapse pattern could be found during drug-induced sleep endoscopy. In one patient, no obstruction at all was seen at the soft palatal level. Only one patient still presented with a complete concentric collapse at velum level. AHI decreased from mean 34.7 events per hour to 20.2/h and oxygen desaturation index from 25.3 events per hour to 16.1/h.

Conclusion

Patients seeking for positive airway pressure alternatives could not only benefit from reduction of AHI by TE-UPPP postoperatively; additionally, by changing the collapse pattern at the soft palate, they might also fulfill criteria for upper airway stimulation (UAS) in case of persistent OSA of at least moderate degree.

Keywords

Sleep endoscopy Sleep apnea UPPP CPAP failure Upper airway stimulation VOTE classification 

Notes

Compliance with ethical standards

Conflict of interest

Katrin Hasselbacher received personal fees and travel expenses from Inspire Medical Systems.

Armin Steffen has received reimbursement of conference fees and travel and accommodation expenses, fees for preparing scientific continuing professional development or other events, funding for research he himself initiated, and fees for conducting clinical studies on related subjects from Inspire Medical Systems and Resmed.

All other authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (place name of institute/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Retrospective studies

For this type of study, formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Weaver TE, Grundstein RR (2008) Adherence to continuous positive airway pressure therapy: the challenge to effective treatment. Proc Am Thorac Soc 5(2):173–178CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Bartlett D, Wong K, Richards D, Moy E, Espie CA, Cistulli PA, Grunstein R (2013) Increasing adherence to obstructive sleep apnea treatment with a group social cognitive therapy treatment intervention: a randomized trial. Sleep 36(11):1647–1654CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Franklin KA, Anttila H, Axelsson S, Gislason T, Maasilta P, Myhre KI, Rehnqvist N (2009) Effects and side-effects of surgery for snoring and obstructive sleep apnea—a systematic review. Sleep 32:27–36PubMedPubMedCentralGoogle Scholar
  4. 4.
    Pirsig W, Schäfer J, Yildiz F, Nagel J (1989) Uvulopalatopharyngoplastik ohne Komplikationen: eine Modifikation nach Fujita. Laryngorhinootologie 68:585–590CrossRefPubMedGoogle Scholar
  5. 5.
    Verse T, Stuck BA (2017) Moderne Modifikationen der Uvulopalatopharyngoplastik. HNO 65:90–98CrossRefPubMedGoogle Scholar
  6. 6.
    Maurer JT (2009) Update on surgical treatment for sleep apnoea. Swiss Med Wkly 139:624PubMedGoogle Scholar
  7. 7.
    Yaremchuk K, Tacia B, Peterson E, Roth T (2011) Change in Epworth Sleepiness Scale after surgical treatment of obstructive sleep apnea. Laryngoscope 121:1590–1593CrossRefPubMedGoogle Scholar
  8. 8.
    Browaldh N, Friberg D, Svanborg E, Nerfeldt P (2011) 15-year efficacy of uvulopalatopharyngoplasty based on objective and subjective data. Acta Otolaryngol 131:1303–1310CrossRefPubMedGoogle Scholar
  9. 9.
    Sommer JU, Heiser C, Gahleitner C, Herr RM, Hörmann K, Maurer JT, Stuck BA (2016) Tonsillectomy with uvulopalatopharyngoplasty in obstructive sleep apnea. Dtsch Arztebl Int 113:1–8PubMedPubMedCentralGoogle Scholar
  10. 10.
    Li H-Y, Wang P-C, Lee L-A, Chen N-H, Fang T-J (2006) Prediction of uvulopalatopharyngoplasty outcome: anatomy-based staging system versus severity-based staging system. Sleep 29:1537–1541CrossRefPubMedGoogle Scholar
  11. 11.
    Sher AE, Schechtman KB, Piccirillo JF (1996) The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep 19(2):156–177CrossRefPubMedGoogle Scholar
  12. 12.
    Boudewyns A, Van de Heyning P, De Backer W (1997) Site of upper airway obstruction in obstructive apnoea and influence of sleep stage. Eur Respir J 10:2566–2572CrossRefPubMedGoogle Scholar
  13. 13.
    De Vito A, Carrasco Llatas M, Vanni A, Bosi M, Braghiroli A, Campanini A, de Vries N, Hamans E, Hohenhorst W, Kotecha BT, Maurer JT, Montevecchi F, Piccin O, Sorrenti G, Vanderveken OM, Vicini C (2014) European position paper on drug-induced sedation endoscopy (DISE). Sleep Breath 18:453–465CrossRefPubMedGoogle Scholar
  14. 14.
    Steffen A, Frenzel H, Wollenberg B, König IR (2015) Patient selection for upper airway stimulation: is concentric collapse in sleep endoscopy predictable? Sleep Breath 19(4):1373–1376CrossRefPubMedGoogle Scholar
  15. 15.
    Kezirian EJ, Hohenhorst W, de Vries N (2011) Drug-induced sleependoscopy: the VOTE classification. Eur Arch Otorhinolaryngol 268:1233–1236CrossRefPubMedGoogle Scholar
  16. 16.
    Boudewyns AN, De Backer WA, Van de Heyning PH (2001) Pattern of upper airway obstruction during sleep before and after uvulopalatopharyngoplasty in patients with obstructive sleep apnea. Sleep Med 2:309–315CrossRefPubMedGoogle Scholar
  17. 17.
    Johns M (1991) A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep 14:540–545CrossRefPubMedGoogle Scholar
  18. 18.
    Iber C, Ancoli-Israel S, Chessonn A, Quan SF (2007) AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. American Academy of Sleep Medicince, WestchesterGoogle Scholar
  19. 19.
    Heiser C, Fthenakis P, Hapfelmeier A, Berger S, Hofauer B, Hohenhorst W, Kochs E, Wagner KJ, Edenharter G (2017) Drug-induced sleep endoscopy with target-controlled infusion using propofol and monitored depth of sedation to determine treatment strategies in obstructive sleep apnea. Sleep Breath 21:737–744CrossRefPubMedGoogle Scholar
  20. 20.
    Hörmann K, Erhardt T, Hirth K, Maurer J (2001) Der modifizierte Uvulalappen zur Therapie schlafbezogener Atmungsstörungen. HNO 49(5):361–366CrossRefPubMedGoogle Scholar
  21. 21.
    Strollo PJ, Rogers RM (1996) Obstructive sleep apnea. N Engl J Med 334:99–104CrossRefPubMedGoogle Scholar
  22. 22.
    Riemann D, Baum E, Cohrs S, Crönlein T, Hajak G, Hertenstein E, Klose P, Langhorst J, Mayer G, Nissen C, Pollmächer T, Rabstein S, Schlarb A, Sitter H, Weeß H-G, Wetter T, Spiegelhalder K (2017) S3-Leitlinie Nicht erholsamer Schlaf/Schlafstörungen. Somnologie 21:2–44CrossRefGoogle Scholar
  23. 23.
    Browaldh N, Nerfeldt P, Lysdahl M, Bring J, Friberg D (2013) SKUP3 randomised controlled trial: polysomnographic results after uvulopalatopharyngoplasty in selected patients with obstructive sleep apnoea. Thorax 68:846–853CrossRefPubMedGoogle Scholar
  24. 24.
    Kezirian EJ (2011) Nonresponders to pharyngeal surgery for obstructive sleep apnea: insights from drug-induced sleep endoscopy. Laryngoscope 121(6):1320–1326CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Hohenhorst W, Raveslott MJL, Kezirian EJ, de Vries N (2012) Drug-induced sleep endoscopy in adults with sleep-disordered breathing: technique and the VOTE classification system. Oper Tech Otolaryngol 13:11–18CrossRefGoogle Scholar
  26. 26.
    Vroegop AV, Vanderveken OM, Wouters K et al (2013) Observer variation in drug-induced sleep endoscopy: experienced versus nonexperienced ear, nose, and throat surgeons. Sleep 36:947–953CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Vanderveken OM, Maurer JT, Hohenhorst W, Hamans E, Lin HS, Vroegop AV, Anders C, de Vries N, Van de Heyning PH (2013) Evaluation of drug-induced sleep endoscopy as a patient selection tool for implanted upper airway stimulation for obstructive sleep apnea. J Clin Sleep Med 9:433–438PubMedPubMedCentralGoogle Scholar
  28. 28.
    Ong AA, Murphey AW, Nguyen SA, Soose RJ, Woodson BT, Vanderveken OM, de Vries N, Gillespie MB (2016) Efficacy of upper airway stimulation on collapse patterns observed during drug-induced sedation endoscopy. Otolaryngol Head Neck Surg 154:970–977CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of OtorhinolaryngologyUniversity of LübeckLübeckGermany

Personalised recommendations