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ΣΥΝΔΡΟΜΟ ΑΠΝΟΙΩΝ ΣΤΟΝ ΥΠΝΟ ΚΑΙ ΧΕΙΡΟΥΡΓΙΚΗ ΤΟΥ ΦΑΡΥΓΓΑ

ΣΥΝΔΡΟΜΟ ΑΠΝΟΙΩΝ ΣΤΟΝ ΥΠΝΟ ΚΑΙ ΧΕΙΡΟΥΡΓΙΚΗ ΤΟΥ ΦΑΡΥΓΓΑ. “Effects and Side-Effects” Γιάννης Νικολόπουλος Πνευμονολόγος/Εντατικολόγος ΚΑΑ-ΜΕΘ, ΝΝΘΑ «ΣΩΤΗΡΙΑ». Surgical Therapy for OSAS. Uvulopalatopharyngoplasty. Uvulopalatal Flap. ΑΞΙΟΛΟΓΗΣΗ ΑΠΟΤΕΛΕΣΜΑΤΙΚΟΤΗΤΑΣ ΜΙΑΣ ΘΕΡΑΠΕΙΑΣ.

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ΣΥΝΔΡΟΜΟ ΑΠΝΟΙΩΝ ΣΤΟΝ ΥΠΝΟ ΚΑΙ ΧΕΙΡΟΥΡΓΙΚΗ ΤΟΥ ΦΑΡΥΓΓΑ

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  1. ΣΥΝΔΡΟΜΟ ΑΠΝΟΙΩΝ ΣΤΟΝ ΥΠΝΟ ΚΑΙ ΧΕΙΡΟΥΡΓΙΚΗ ΤΟΥ ΦΑΡΥΓΓΑ “Effects and Side-Effects” Γιάννης Νικολόπουλος Πνευμονολόγος/Εντατικολόγος ΚΑΑ-ΜΕΘ, ΝΝΘΑ «ΣΩΤΗΡΙΑ»

  2. Surgical Therapy for OSAS

  3. Uvulopalatopharyngoplasty

  4. Uvulopalatal Flap

  5. ΑΞΙΟΛΟΓΗΣΗ ΑΠΟΤΕΛΕΣΜΑΤΙΚΟΤΗΤΑΣ ΜΙΑΣ ΘΕΡΑΠΕΙΑΣ Endpoints/Outcomes: Symptoms, PSG Indices, Complications.

  6. Chest 2002;121;739-746 Success rate (percentage of pts with at least 50% reduction in AI) in UPPP group53%. Normalization (AI < 5 or apnea/hypopnea index < 10) in 33% of UPPP group after 4 years.

  7. Individual AI values (n 32) in the UPPP groupbefore intervention and at the 1-year and 4-year follow-ups. Chest 2002;121;739-746

  8. Adverse Effects of UPPP Three patients showed a tendency to fibroticNarrowing. Pronouncedcomplaints ofnasopharyngeal regurgitationof fluid and difficulty with swallowing after UPPPwere reported by 8% and 10%, respectively. Chest 2002;121;739-746

  9. A Randomized Trial of Laser-assisted Uvulopalatoplastyin the Treatment of Mild Obstructive Sleep ApneaAm J Respir Crit Care Med Vol 167. pp 15–19, 2003 CLINICAL AND RESPIRATORY VARIABLES BEFORE AND AFTER TREATMENT The AHIpost-LAUP was reduced by 21% overall and to 10 or less per hour in 5 of 21 subjects (24%).

  10. Side Effects and Complications • Seventeen subjects (81%)reported moderate to severe pain • Four subjects (19%) had persistentdifficulty swallowing still present at outcome. • Five (24%) reported moderate to severe bleeding episodes • Five subjects(24%) had nasal regurgitation for a brief period after surgery CONCLUSION LAUP surgery is effective in some subjects with mild OSA forthe treatment of snoring, but the reduction in AHI and the level of symptomatic improvement were minor overall. Am J Respir Crit Care Med Vol 167. pp 15–19, 2003

  11. Uvulopalatopharyngoplasty in the Management of Obstructive Sleep Apnea:The Mayo Clinic ExperienceMayo Clin Proc. 2009;84(9):795-800

  12. AHI of 10 or less in 33% of patients with OSA Patientswho attained an AHI of 5 or less • were younger (P=.05), • had a lower body mass index(BMI) (P=.05). • had less severe OSA(P=.004), and • had higherpreoperative minimum oxygen saturation (P=.04). Mayo Clin Proc. • September 2009;84(9):795-800

  13. Laryngoscope, 118:902–908, 2008

  14. 49 articles.1,978 pts, follow-up time7.3 months a meta-analysis redefined the success rate “a reduction in AHIof 50% or more and an AHI of less than 20.”

  15. Postoperative AHI increased in 9.8% (13.2% with mild/moderate and6.9% with severe disease). • Complication rate is 14.6%. 16% inmild/moderate and 14.2% in severe disease. CONCLUSION • CPAP remains the first-line standard treatment forOSAHS. • surgery for OSAHS is associatedwith improved outcomes. This benefitissupported by level-4evidence. Laryngoscope, 118:902–908, 2008

  16. SLEEP, Vol. 32, No. 1,2009 Efficacy: 4 parallel, randomized, controlled trials of high quality Adverse effects:45 observational studies Primary outcomes:Daytime Sleepiness, Quality of life. Secondary outcomes:AHI and severity of Snoring.

  17. Efficacy • No significant effect on Sleepiness or QOL • AHI and Snoring reduced in Ferguson study • Snoring reduced in Stuck study • No trial investigating any other surgical modality met the inclusion criteria. SLEEP, Vol. 32, No. 1, 2009

  18. Severe complications UPPP: death, bleedings and respiratory compromise, in 0% to 16% of pts, with higher frequencies in studies 1980s • Respiratory compromise, bleedings, intubation difficulties, • infections, and cardiac arrest were the main causes of death. • Kezirian 2004: 3,130 operations death in 0.2% and • serious complicationsin 1.5%

  19. Severe complications UPPP Other reported side-effects:globus sensation, smell disturbances, and single cases of velopharyngeal insufficiency SLEEP, Vol. 32, No. 1, 2009

  20. Uvulopalatoplastycomplications up to 5%: peri/post-operative bleedings, infections, with one death from septicemia • Other side-effects: voice changes, smell disturbances, • taste disturbances, and single cases of velopharyngeal stenosis • No studies of any other surgical modality meeting theinclusion criteria for adverse effects were found. SLEEP, Vol. 32, No. 1, 2009

  21. Conclusions • Only a small number of randomized controlled trials with a limited number of patients assessing some surgical modalities for snoring or sleep apnea are available. • These studies do not provide any evidence of effect from laser-assisted uvulopalatoplasty or radiofrequency ablation on daytime sleepiness, apnea reduction, quality of life or snoring. SLEEP, Vol. 32, No. 1, 2009

  22. Ευχαριστώ πολύ για την προσοχή σας!

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