Z-palatopharyngoplasty plus genioglossus advancement and hyoid suspension for obstructive sleep apnea hypopnea syndrome.

OBJECTIVE

To explore the feasibility and efficiency of Z-palato-pharyngoplasty (ZPPP) plus genioglossus advancement and hyoid suspension (GAHM) for severe obstructive sleep apnea hypopnea syndrome (OSAHS).

STUDY DESIGN

Case series with planned data collection.

SETTING

A university medical center.

SUBJECTS AND METHODS

Twenty-six patients who had OSAHS with Friedman obstructive sleep apnea stage II/III and posterior airway space <11 mm received GAHM and ZPPP. All patients were reevaluated 6 months after surgery using the preoperative methods.

RESULTS

Based on success criteria, defined as an apnea-hypopnea index (AHI) of <20 and a decrease >50%, the success rate was 46.2% at 6 months postoperatively. The AHI showed a significant reduction from 65.6 ± 17.6 preoperatively to 30.1 ± 23.1 postoperatively. The percentage of time with oxyhemoglobin saturation below 90% (CT(90)) decreased from 30.9% ± 28.1% preoperatively to 15.5% ± 25.6% postoperatively (P < .01). Sleep architecture was effectively changed. The S3 + S4 percentage of total sleep time increased from 3.6% ± 4.4% to 8.7% ± 5.0% (P < .05). The success rates were 100% (8/8) and 22.2% (4/18) in patients with Friedman obstructive sleep apnea stage II and III, respectively.

CONCLUSION

The success rate of ZPPP plus GAHM for patients with severe OSAHS who suffer from oropharyngeal and hypopharyngeal obstruction was limited. Friedman stage was a predictor of ZPPP plus GAHM surgical success.