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[Multi-level surgery for obstructive sleep apnea. Preliminary objective results].

T Verse1, A Baisch, K Hörmann

  • 1Universitäts-HNO-Klinik, Mannheim. thomas.verse@hno.ma.uni-heidelberg.de

Laryngo- Rhino- Otologie
|August 19, 2004
PubMed
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The Mannheim concept for obstructive sleep apnea (OSA) surgery showed a 69.6% response rate, with 39.1% cured. However, success was lower than more invasive methods, possibly due to excluding mandibular osteotomy.

Area of Science:

  • Otolaryngology
  • Sleep Medicine
  • Surgical Innovation

Background:

  • Nasal continuous positive airway pressure (nCPAP) has limited long-term compliance for obstructive sleep apnea (OSA).
  • Multi-level surgeries combining velopharyngeal and retrolingual airway procedures are gaining interest.
  • The Mannheim concept integrates soft palate surgery (UPPP or Uvulaflap), tonsillectomy, and hyoid suspension/radiofrequency tongue base treatment.

Purpose of the Study:

  • To evaluate the efficacy of the Mannheim multi-level surgical concept for treating obstructive sleep apnea (OSA).
  • To assess the impact of surgical intervention on apnea-hypopnea index (AHI) and daytime sleepiness (ESS).

Main Methods:

  • A cohort of 139 OSA patients underwent the Mannheim surgical concept between July 2000 and February 2003.

Related Experiment Videos

  • Pre- and postoperative polysomnography (PSG) and Epworth Sleepiness Scale (ESS) assessments were performed.
  • Follow-up data was available for 46 patients, with a mean age of 51.9 years and BMI of 28.5 kg/m².

    • Main Results:

    • The mean apnea-hypopnea index (AHI) decreased from 36.5 to 24.9 (p < 0.01), and mean ESS score decreased from 10.4 to 7.1 (p < 0.05).
    • Overall, 69.6% of patients were considered responders, with 39.1% achieving cure (AHI < 15 and ≥50% reduction).
    • Hyoid suspension positively influenced treatment success, though cure rates decreased with higher AHI and BMI.

    Conclusions:

    • The Mannheim concept demonstrated moderate success in treating OSA, with significant reductions in AHI and ESS.
    • The observed success rates were lower compared to more invasive surgical approaches.
    • Exclusion of mandibular osteotomy with genioglossus advancement may contribute to the comparatively lower efficacy.