Halme Perttu, Toskala Elina, Laurikainen Esa, Antila Jukka, Tsushima Yoshito, Polo Olli
Department of Otorhinolaryngology-Head and Neck Surgery, Turku University Hospital, Turku, Finland.
Acta Otolaryngol. 2010 May;130(5):614-9. doi: 10.3109/00016480903311872.
Patients with upper airway narrowing at the soft palate level and partial upper airway obstruction during sleep seem to benefit from laser-assisted uvulopalatoplasty (LUPP) in terms of decreased velopharyngeal collapsibility and improved nocturnal breathing.
The current operative treatments for obstructive sleep apnea syndrome (OSAS) are not very effective compared with continuous positive airway pressure (CPAP). It has been suggested that active treatment should be performed earlier, when sleep apnea is present in a milder form. The main problem is identifying progressive sleep apnea. The present study assessed the efficacy of LUPP in patients with partial upper airway obstruction during sleep diagnosed by means of a static charge-sensitive bed (SCSB) combined with oxyhemoglobin desaturation recording and digital fluoroscopy-based collapsibility estimation.
LUPP was carried out in 27 patients under local anesthesia as day surgery. Digital fluoroscopy and SCSB were recorded preoperatively and 6 months after LUPP.
Partial upper airway obstruction events and arterial oxyhemoglobin desaturations during sleep decreased significantly. Digital fluoroscopy revealed that the minimal anteroposterior dimension increased and collapsibility decreased at the level where velopharyngeal obstruction occurred, the soft palate.
软腭水平上气道狭窄且睡眠期间存在部分上气道阻塞的患者，似乎能从激光辅助悬雍垂腭咽成形术（LUPP）中获益，即咽鼓管咽口塌陷性降低，夜间呼吸改善。
与持续气道正压通气（CPAP）相比，目前阻塞性睡眠呼吸暂停综合征（OSAS）的手术治疗效果不太理想。有人提出，当睡眠呼吸暂停以较轻形式出现时，应尽早进行积极治疗。主要问题是识别进行性睡眠呼吸暂停。本研究评估了LUPP对通过静态电荷敏感床（SCSB）结合氧合血红蛋白去饱和记录及基于数字荧光透视的塌陷性估计诊断出的睡眠期间部分上气道阻塞患者的疗效。
27例患者在局部麻醉下作为日间手术接受LUPP。术前及LUPP术后6个月记录数字荧光透视和SCSB。
睡眠期间部分上气道阻塞事件及动脉氧合血红蛋白去饱和显著减少。数字荧光透视显示，在咽鼓管咽口阻塞发生的水平即软腭处，最小前后径增加，塌陷性降低。
