Clinical study on obstructive sleep apnea following pharyngeal flap surgery

doi:10.7518/hxkq.2021.05.011

Abstract

Abstract: Objective

This study aims to investigate the incidence and severity of obstructive sleep apnea (OSA) in cleft patients with velopharyngeal insufficiency (VPI) after pharyngeal flap surgery (PFS) and explore the influence of operation age.

Methods

A retrospective study was conducted in 82 cleft patients after PFS. The patients were divided into two groups according to their age at the time of surgery. The incidence and severity of OSA were assessed at least 1.2 years (mean 6.0 years) postoperatively by polysomnography (PSG).

Results

The incidence rates of OSA were 20% in the adult group and 31% in the child group. No significant difference was found between the two groups (P=0.289). Patients with OSA in the adult and child groups were classified into different levels of severity (mild, moderate, severe) according to the apnea hypoventilation index (AHI). No statistically significant difference in the severity of OSA was found between the two groups (P=0.079).

Conclusion

Some patients still have OSA average of 6.0 years after PFS, and operation ageis unrelated to the incidence and severity of OSA.

Key words: obstructive sleep apnea, cleft palate, polysomnography, velopharyngeal insufficiency, pharyngeal flap surgery

CLC Number:

R 782.2⁺2

Zhao Ning, Liu Zhenguo, Xu Yaoxiang, Yue Jin, Xue Lingfa, Xiao Wenlin. Clinical study on obstructive sleep apnea following pharyngeal flap surgery[J]. West China Journal of Stomatology, 2021, 39(5): 566-569.

Figures/Tables 2

References 18

1	Liao YF, Noordhoff MS, Huang CS, et al. Comparison of obstructive sleep apnea syndrome in children with cleft palate following Furlow palatoplasty or pharyngeal flap for velopharyngeal insufficiency[J]. Cleft Palate Craniofac J, 2004, 41(2): 152-156.
2	Skirko JR, Weaver EM, Perkins JA, et al. Change in quality of life with velopharyngeal insufficiency surgery[J]. Otolaryngol Head Neck Surg, 2015, 153(5): 857-864.
3	Yamaguchi K, Lonic D, Lee CH, et al. A treatment protocol for velopharyngeal insufficiency and the outcome[J]. Plast Reconstr Surg, 2016, 138(2): 290e-299e.
4	Collins J, Cheung K, Farrokhyar F, et al. Pharyngeal flap versus sphincter pharyngoplasty for the treatment of velopharyngeal insufficiency: a meta-analysis[J]. J Plast Reconstr Aesthet Surg, 2012, 65(7): 864-868.
5	Sirois M, Caouette-Laberge L, Spier S, et al. Sleep apnea following a pharyngeal flap: a feared complication[J]. Plast Reconstr Surg, 1994, 93(5): 943-947.
6	Lesavoy MA, Borud LJ, Thorson T, et al. Upper airway obstruction after pharyngeal flap surgery[J]. Ann Plast Surg, 1996, 36(1): 26-30.
7	Wells MD, Vu TA, Luce EA. Incidence and sequelae of nocturnal respiratory obstruction following posterior pharyngeal flap operation[J]. Ann Plast Surg, 1999, 43(3): 252-257.
8	Sher AE, Schechtman KB, Piccirillo JF. The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome[J]. Sleep, 1996, 19(2): 156-177.
9	Kravath RE, Pollak CP, Borowiecki B, et al. Obstructive sleep apnea and death associated with surgical correction of velopharyngeal incompetence[J]. J Pediatr, 1980, 96(4): 645-648.
10	邱叶, 郑谦, 石冰, 等. 大年龄腭裂患者术后腭咽闭合功能的影响因素[J]. 华西口腔医学杂志, 2014, 32(1): 54-57.
	Qiu Y, Zheng Q, Shi B, et al. Influential factors affecting the postoperative velopharyngeal function among aged cleft palate patients[J]. West China J Stomatol, 2014, 32(1): 54-57.
11	American Academy of Sleep Medicine. International classification of sleep disorder[M]. 3rd ed. Darien, IL: American Academy of Sleep Medicine, 2014.
12	Sullivan SR, Marrinan EM, Mulliken JB. Pharyngeal flap outcomes innonsyndromic children with repaired cleft palate and velopharyngeal insufficiency[J]. Plast Reconstr Surg, 2010, 125(1): 290-298.
13	MacLean JE, Hayward P, Fitzgerald DA, et al. Cleft lip and/or palate and breathing during sleep[J]. Sleep Med Rev, 2009, 13(3): 345-354.
14	Orr WC, Levine NS, Buchanan RT. Effect of cleft palate repair and pharyngeal flap surgery on upper airway obstruction during sleep[J]. Plast Reconstr Surg, 1987, 80(2): 226-232.
15	Liao YF, Chuang ML, Chen PKT, et al. Incidence and severity of obstructive sleep apnea following pharyngeal flap surgery in patients with cleft palate[J]. Cleft Palate Craniofac J, 2002, 39(3): 312-316.
16	Campos LD, Trindade-Suedam IK, Sampaio-Teixeira AC, et al. Obstructive sleep apnea following pharyngeal flap surgery for velopharyngeal insuffciency: a prospective polysomnographic and aerodynamic study in middle-aged adults[J]. Cleft Palate Craniofac J, 2016, 53(3): e53-e59.
17	Tufik S, Santos-Silva R, Taddei JA, et al. Obstructive sleep apnea syndrome in the Sao Paulo Epidemiologic Sleep Study[J]. Sleep Med, 2010, 11(5): 441-446.
18	Lin KY, Goldberg D, Williams C, et al. Long-term outcome analysis of two treatment methods for cleft palate: combined levator retropositioning and pharyngeal flap versus double-opposing Z-plasty[J]. Cleft Palate Craniofac J, 1999, 36(1): 73-78.

项目		成人组	儿童组
患者人数/例	男	16	25
	女	14	27
腭裂裂型/例	双侧完全性腭裂	6	11
	单侧完全性腭裂	9	20
	不完全腭裂	15	21
腭裂修复手术术式/例	兰式法	8	5
	Furlow腭成形术	7	16
	两瓣法	5	18
	两瓣法+犁骨瓣法	-	10
	未知（外院手术）	10	3
咽后壁瓣手术年龄/年		23.3±4.2	8.9±4.1
随访时间/年		5.9±2.2	6.1±2.1

组别			n	AHI/h	LSaO₂/%
成人组（n=30）	正常		24	1.6±1.0	91±2
	轻度 OSA		6	9.7±2.8	88±3
	中度 OSA		0	-	-
	重度 OSA		0	-	-
儿童组（n=52）	正常	未成年	26	0.5±0.3	92±3
		已成年	10*	2.5±1.2	91±3
	轻度 OSA		10	2.6±0.9	90±4
	中度 OSA		6	7.8±1.3	88±4
	重度 OSA		0	-	-

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