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Lateral oropharyngeal wall and supraglottic airway collapse associated with failure in sleep apnea surgery

Authors

  • Danny Soares MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Wayne State University and Karmanos Cancer Institute, Detroit
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  • Hadeer Sinawe BS,

    1. Department of Otolaryngology–Head and Neck Surgery, Wayne State University and Karmanos Cancer Institute, Detroit
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  • Adam J. Folbe MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Wayne State University and Karmanos Cancer Institute, Detroit
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  • George Yoo MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Wayne State University and Karmanos Cancer Institute, Detroit
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  • Safwan Badr MD,

    1. Department of Medicine, John D. Dingell VA Medical Center, Detroit
    2. Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Wayne State University, Detroit, Michigan, U.S.A.
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  • James A. Rowley MD,

    1. Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Wayne State University, Detroit, Michigan, U.S.A.
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  • Ho-Sheng Lin MD

    Corresponding author
    1. Department of Otolaryngology–Head and Neck Surgery, Wayne State University and Karmanos Cancer Institute, Detroit
    2. Department of Surgery, John D. Dingell VA Medical Center, Detroit
    • 4201 St. Antoine St., 5E University Health Center, Detroit, MI 48201
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  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

To identify patterns of airway collapse during preoperative drug-induced sleep endoscopy (DISE) as predictors of surgical failure following multilevel airway surgery for patients with obstructive sleep apnea-hypopnea syndrome (OSAHS).

Study Design:

Retrospective clinical chart review.

Methods:

Medical records of patients who underwent site-specific surgical modification of the upper airway for treatment of OSHAS were reviewed. Patients were included in this study if they had a preoperative airway evaluation with DISE as well as preoperative and postoperative polysomnography. Airway obstruction on DISE was described according to airway level, severity, and axis of collapse. Severe airway obstruction was defined as >75% collapse on endoscopy. Surgical success was described as a postoperative apnea-hypopnea index (AHI) of <20 and a >50% decrease in preoperative AHI.

Results:

A total of 34 patients were included in this study. The overall surgical success rate was 56%. Surgical success (n = 19) and surgical failure (n = 15) patients were similar with regard to age, gender, body mass index, preoperative AHI, Friedman stage, adenotonsillar grades, and surgical management. DISE findings in the surgical failure group demonstrated greater incidence of severe lateral oropharyngeal wall collapse (73.3% vs. 36.8%, P = .037) and severe supraglottic collapse (93.3% vs. 63.2%, P = .046) as compared to the surgical success group.

Conclusions:

The presence of severe lateral pharyngeal wall and/or supraglottic collapse on preoperative DISE is associated with OSAHS surgical failure. The identification of this failure-prone collapse pattern may be useful in preoperative patient counseling as well as in directing an individualized and customized approach to the treatment of OSHAS.

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