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ABSTRACT: To evaluate the clinical value of localization of upper airway obstructive site with pressure measurements and Friedman staging system in preoperative upper airway reconstructive surgery for obstructive sleep apnea-hypopnea syndrome (OSAHS), and to evaluate the value of Friedman staging system in predicting the upper airway obstructive site.
One hundred and three patients with snoring, daytime sleepiness diagnosed as OSAHS by polysomnography were first classified using Friedman staging system, and then examined using whole night recording, including airway continuous pressure measurements (Apnea Graph, AG). AG transducer catheter containing two pressure and two temperature sensors used for obstruction site determination and detection of apnea events during sleep. Obstructive sites were divided into upper (retropalatal region) or lower level (retroglossal region). Using constituent ratio to reflect the obstructive proportion of different levels so as to find the correlation between Friedman staging system and localization of upper airway obstructive site with pressure measurements performed during sleep, and to evaluate the clinical value of Friedman staging system in predicting the severity of OSAHS.
There was statistically significant difference in the constituent ratio of retroglossal obstruction determined by AG, according to Friedman staging system, Friedman tongue position (FTP) and tonsil size grading (F = 13.876, 7.655, 10.207 respectively, P < 0.05). The constituent ratio of retroglossal obstruction between stage IV and I, II, III (P < 0.01) was significantly different. With the increasing of Friedman staging, the constituent ratio of retroglossal obstruction had the tendency of increasing. The constituent ratio of retroglossal obstruction between FTP grade 2 and grade 3, grade 4 (P < 0.05) was significantly different. With the increasing of FTP grading, the constituent ratio of retroglossal obstruction had the tendency of increasing. The constituent ratio of retroglossal obstruction between the Friedman tonsil size grade 4 and grade 1, grade 3 (P < 0.01), grade 2 (P < 0.05) was significantly different.
Friedman staging system, in particular the FTP grading, had a correlation with upper airway pressure measurements (AG) in determination of the lower level of upper airway obstructive site, especially the retroglossal region, which could predict the main localization of upper airway obstructive site identified by upper airway pressure measurements during the sleep.
Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery 08/2011; 46(8):622-7.
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ABSTRACT: To determine whether there was agreement between the short daytime ApneaGraph (dAG) and nocturnal ApneaGraph (nAG) in diagnosing sleep respiratory events initially and identifying the site of obstruction in airway.
Twenty four patients diagnosed OSAHS by PSG were enrolled. The apnea-hypopnea index (AHI), apnea index (AI), obstructive apnea-hypopnea index (OAHI), central apnea hypopnea index (CAHI), mixed apnea index (MAHI), lowest oxygen saturation (LSaO2) and the proportion of upper/lower obstruction (UPPER, LOWER) of patients were measured using both dAG and nAG.
There were no significant differences between nAG and dAG for the following parameters: AHI, AI, CAHI, MAHI, OAHI, the proportion of upper/lower obstruction, or LSaO2 (P>0.05). There were significant positive correlations between nAG and dAG with regard to AHI, AI, MAHI, OAHI, the proportion of upper/lower obstruction , LSaO2 except CAHI.
The dAG has similar results with nAG in early diagnosis of sleep respiratory events and identifying the level of airway obstruction. The time-saving dAG is of considerable referential importance in diagnosis of sleep respiratory events and analysing the level of airway obstruction.
Lin chuang er bi yan hou ke za zhi = Journal of clinical otorhinolaryngology 04/2011; 25(7):317-9, 323.
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ABSTRACT: The aim of this study was to determine whether the 2-h daytime ApneaGraph (dAG) for patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) can be used initially to diagnose and identify the site of obstruction before surgery. Fifty patients with OSAHS diagnosed by polysomnogram were enrolled in this prospective study. Sleep-related parameters, which include the indices for apnea-hypopnea (AHI), apnea index (AI), obstructive, central and mixed AHI (OAHI, CAHI and MAHI, respectively), the lowest oxygen saturation (LSaO₂) and the proportion of upper and lower airway obstruction (UPPER and LOWER, respectively), were measured by both daytime and nocturnal AG (nAG). Different operative techniques were used according to the obstruction site assessed by the nAG. Clinical outcomes were assessed with the Epworth Sleepiness Scale (ESS), visual analog scale (VAS), AI, AHI and LSaO₂. All the indices except LSaO₂ found no significant differences between dAG and nAG; there were significant positive correlations with regard to most indices, but not for CAHI between dAG and nAG. When compared dAG with nAG, most moderate and severe patients had predominant sites of obstructions in the upper level. Postoperative ESS, VAS, AI and AHI decreased significantly, while LSaO₂ significantly increased compared with those preoperative counterparts. dAG may be used as an alternative means for early and low-cost diagnostic evaluation of OSAHS before surgery.
Archives of Oto-Rhino-Laryngology 03/2011; 268(11):1663-9. · 1.29 Impact Factor
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ABSTRACT: To develop a simplified Chinese version of the 32-item Quebec sleep questionnaire (QSQ) and to examine the reliability and validity.
A cross-sectional sample of 141 patients [22 simple snorers and 119 obstructive sleep apnea hypopnea syndrome (OSAHS)] and a longitudinal sample of 55 patients [35 in uvulopalatopharyngoplasty (UPPP) group and 20 in control group] completed the simplified Chinese version of QSQ for assessment of its feasibility, reliability, validity and responsiveness.
QSQ had good feasibility. All internal consistency coefficients exceeded 0.65. Intraclass correlation coefficients of five domains for test-retest reliability ranged from 0.82 - 0.91. There were significant differences in four domains (daytime sleepiness, diurnal symptoms, nocturnal symptoms and social interactions) among patients with different severity of apnea hypopnea index (AHI) and lowest saturation of arterial oxygen (LSaO2, P < 0.01 or < 0.05). Correlations between QSQ scores and five domains and Epworth sleepiness scale (ESS) were statistically significant (P < 0.01). Correlations between QSQ scores and three domains (daytime sleepiness, nocturnal symptoms and social interactions) and polysomnography (PSG) indices (AHI and LSaO2) were statistically significant (P < 0.05). There were significant differences in scores of five domains of patients between at baseline and after UPPP. There were significant differences in change scores of five domains between patients who were treated and those who were not.
The simplified Chinese version of QSQ offers good reliability, validity and responsiveness and can be used as a OSAHS-specific instrument to assess impact of illness and treatment effectiveness in OSAHS patients.
Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery 02/2011; 46(2):101-7.
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ABSTRACT: To assess the effect of upper airway reconstructive surgery for moderate to severe obstructive sleep apnea-hypopnea syndrome (OSAHS) with the obstructive sites determined by pressure measurements, and to evaluate the clinical value of upper airway manometry in localizing the obstructive sites.
Fifty-one moderate to severe OSAHS patients were examined using whole night recording, including airway continuous pressure measurements (ApneaGraph, MRA-Medical Ltd, UK). ApneaGraph (AG) transducer catheter contains two pressure and two temperature sensors used for obstruction site determination and detection of apnoeic events during sleep. Obstructive sites were divided into upper (retropalatal region) and lower level (retroglossal region). The lower limit of obstruction was determined by AG pressure pattern. Using constituent ratio to reflect the obstructive proportion of different levels. All patients were divided into two groups (retropalatal or retroglossal) according to the primary obstructive level. The patients of retropalatal group were treated with modified uvulopalatopharyngoplasty (UPPP), or plus hard palate shortening. The patients of retroglossal group underwent tongue and palatal surgical procedures such as UPPP, hyoid suspension, radiofrequency ablation of tongue base, genioglossus advancement etc. All patients were followed-up at least 6 months using Apneagraph. Clinical outcomes included the Epworth sleeping scale (ESS), apnea-hypopnea index (AHI) and lowest arterial oxygen saturation (LSaO2).
Five patients had moderate OSAHS and 46 were severe. Four patients had experienced UPPP failures. The ESS reduced from average 17.6 ± 4.7 to 4.3 ± 4.3 (x(-) ± s, t = 15.195, P < 0.001). The AHI reduced from average 52.4 ± 17.5 to 16.3 ± 18.2 (t = 10.873, P < 0.001). The LSaO2 increased from 0.706 ± 0.099 (x(-) ± s) to 0.823 ± 0.092 (t = -8.396, P < 0.001). The success was defined as a ≥ 50 percent reduction and final apnea-hypopnea index < 20/h, the total success rate was 76.5%. Retropalatal group had 27 patients and 24 cases were in retroglossal group.Their success rate were 81.5% and 75.0% respectively.
The upper airway pressure measurements can identify the level of obstruction accurately and prove to be effective in the treatment of OSAHS.
Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery 12/2010; 45(12):1008-13.
